Prolonged intermittent hemodialysis using a standard dialysate flow rate for severe overdose of sustained-release valproic acid: A case report

Q1 Environmental Science

Toxicology Reports Pub Date : 2025-09-26 DOI:10.1016/j.toxrep.2025.102132

Hiroki Inoue , Satoshi Yoshikawa , Nobuyasu Matsukawa, Atsushi Shima , Takuya Nishizawa , Takeshi Ueda

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Abstract

Background

Valproic acid poisoning can be life threatening and may require urgent extracorporeal elimination. In particular, sustained-release formulations pose a challenge, as conventional short-duration intermittent hemodialysis may fail to remove the drug sufficiently because of delayed and prolonged drug absorption. While prolonged intermittent hemodialysis is a rational alternative, its clinical effectiveness and safety in cases of severe sustained-release sodium valproate overdose have not been reported.

Case

A woman in her 20 s developed coma after ingesting 45 g (approximately 1100 mg/kg) of sustained-release VPA. Prolonged IHD was delivered for 22 h using a blood flow rate (Qb) of 180 mL/min and a dialysate flow rate (Qd) of 500 mL/min. Her consciousness improved in parallel with a marked decline in serum VPA levels, and she was discharged without any neurological sequelae. A two-point, on-dialysis apparent elimination half-life was estimated to be approximately 2.35 h.

Conclusion

In this case, prolonged IHD appeared to have an effect in decreasing VPA concentrations and was safely implemented with monitoring.

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使用标准透析液流速延长间歇血液透析治疗重度过量丙戊酸缓释：1例报告

丙戊酸中毒可危及生命，可能需要紧急体外清除。特别是，缓释制剂带来了挑战，因为传统的短时间间歇性血液透析可能无法充分去除药物，因为延迟和延长药物吸收。虽然长期间歇性血液透析是一种合理的选择，但其在重度丙戊酸钠缓释过量病例中的临床有效性和安全性尚未见报道。病例一名20岁 岁的妇女在摄入45 g（约1100 mg/kg）缓释VPA后出现昏迷。延长IHD为22 h，血流量（Qb）为180 mL/min，透析液流量（Qd）为500 mL/min。她的意识得到改善，同时血清VPA水平显著下降，出院时没有任何神经系统后遗症。两点透析时的表观消除半衰期估计约为2.35 h。结论在本病例中，延长IHD似乎对降低VPA浓度有效果，并且在监测下安全实施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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