Jung Jinhee, Eo Eunkyung, Ahn Ki-ok
Department of Emergency Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
Am J Emerg Med. 2008 Mar;26(3):388.e3-4. doi: 10.1016/j.ajem.2007.07.032.
Valproic acid (VPA) is used to manage a variety of conditions, including simple and complex absence seizure disorder, bipolar disorder, and migraine prophylaxis. The clinical manifestations of VPA overdose range in severity from mild confusion and lethargy to severe coma and death. The treatment of VPA toxicity is mainly supportive. There is no specific antidote or guidelines for managing VPA intoxication. Anecdotal reports describe the efficacy of naloxone and L-carnitine, but the data are insufficient to make strong conclusions. Various extracorporeal techniques for managing VPA toxicity have been described, but none has prevailed as standard therapy. We report a patient with VPA overdose who was treated successfully with hemoperfusion with activated charcoal and L-carnitine. The VPA level of the patient exceeded 1000 microg/mL and was normalized after 3 rounds of hemoperfusion. The patient was injected with L-carnitine at a maximum of 600 mg/kg per day for 5 days without complications.
丙戊酸（VPA）用于治疗多种病症，包括单纯性和复杂性失神癫痫障碍、双相情感障碍以及偏头痛预防。丙戊酸过量的临床表现严重程度不一，从轻度意识模糊和嗜睡到严重昏迷甚至死亡。丙戊酸中毒的治疗主要是支持性治疗。目前尚无用于处理丙戊酸中毒的特效解毒剂或指南。有一些轶事报道描述了纳洛酮和左旋肉碱的疗效，但数据不足以得出有力结论。已描述了多种用于处理丙戊酸毒性的体外技术，但尚无一种成为标准治疗方法。我们报告了一名丙戊酸过量患者，该患者通过活性炭血液灌流和左旋肉碱成功治愈。患者的丙戊酸水平超过1000微克/毫升，经过三轮血液灌流后恢复正常。患者每天最大剂量为600毫克/千克注射左旋肉碱，持续5天，未出现并发症。
