Valproic acid intoxication with suicide attempt in a pediatric patient

Overdose with antiepileptic drugs: the efficacy of extracorporeal removal techniques

“…It has the advantage of removing toxins that are highly bound to serum proteins as activated charcoal competes with plasma proteins for drug binding 10 16 18 24. In our case, CHP led to a reduction of 53% in CBZ and 68% in VPA concentration, similar to other described cases 7 13 17. This technique enhances the body drug clearance, reducing possible side effects and leading to a faster recovery of consciousness, with short intubation and hospitalisation periods.…”

“…This case illustrates the difficulties in the management of a life-threatening toxic ingestion with two different drugs that are extensively bound to serum proteins. Both drugs’ intoxications have to be managed with supportive measures since there are no specific antidotes or treatment guidelines 6 16 17 19 20…”

“…VPA has a molecular weight of 144 Da, a faster absorption rate than CBZ, with peak level occurring 1–4 h after ingestion, which in cases of overdose is usually delayed 7 16. In therapeutic ranges it is 90% protein bound, but in higher levels, VPA protein-binding capacity decreases 7 9 16 17. The relatively low concentrations of both drugs during the first hours can be explained by their slow absorption rate worsened by the fact that both are prolonged release formulations.…”

“…CHP is preferred since it is the most effective way of removing CBZ and VPA, although it is not easily accessible 5–7 10 11 13 14 17 19–23…”

“…Toxic effects are associated with blood levels above that range and central nervous system depression is frequent with levels beyond 180 μg/mL 15. Toxicity of VPA is mainly manifested by neurological symptoms, and can lead to respiratory depression, coma and even death 7 9 16 17. Both drugs are extensively bound to serum proteins and neither one has an antidote; the optimal treatment for intoxication is not clear and should depend on clinical presentation 4.…”