HEMODIALYSIS AND HEMOPERFUSION FOR TREATMENT OF VALPROIC ACID AND GABAPENTIN POISONING

A 31-y-old epileptic man developed coma and shock after suicidally ing esting large amounts of valproic acid and gabapentin. His peak valproi c acid level was 1306.9 mu g/mL (therapeutic range = 30-100 mu g/mL). His peak gabapentin level was 60.0 mu g/mL (therapeutic range = 2.0-8. 0 mu g/mL). his hypotension was refractory to crystalloid and presser infusions, but resolved during concurrent hemoperfusion and hemodialys is to enhance elimination of valproic acid. Concurrent hemoperfusion a nd hemodialysis, In series, produced a maximum valproic acid plasma cl earance of 55.4 mL/min versus a maximum reported intrinsic valproic ac id plasma clearance of 10.6 mL/min. Concurrent hemoperfusion and hemod ialysis, in series, should be considered in hemodynamically unstable p atients with valproic acid poisoning whose clinical condition is worse ning in spite of aggressive supportive care.