Doar Nyier W, Adhikari Samaj, Aryal Binit, Edara Sushma, Schmidt Marie
Internal Medicine, Interfaith Medical Center, Brooklyn, USA.
Pulmonary and Critical Care Medicine, Interfaith Medical Center, Brooklyn, USA.
Cureus. 2023 Jun 27;15(6):e41020. doi: 10.7759/cureus.41020. eCollection 2023 Jun.
Valproic acid poisoning can have mild to fatal consequences depending on its body concentration. There are rare case reports and barely any known controlled studies on the use of hemodialysis as a last treatment resort. We report a rare valproic acid poisoning case at One Brooklyn Health/Interfaith campus, New York City, warranting intubation and hemodialysis. The patient is a 47-year-old male with a past medical history of seizure disorder, polysubstance use disorder, schizophrenia, and gastroesophageal reflux disease (GERD) who was brought to the medical emergency department (ED) for intentional valproic acid overdose with 60 tablets of his prescribed home Depakote DR 500 mg (~30 g). The patient's other outpatient medications included valproic acid, trazodone, acetaminophen, famotidine, fluoxetine, folic acid, hydrocortisone-aloe, multivitamin, nicotine polacrilex, and thiamine. The patient's initial blood tests showed high valproic acid, ammonia, ethanol, and lactate. About six hours after ED admission, the patient became somnolent, desaturated to 74% on a non-rebreather oxygen mask, warranting intubation and hemodialysis after noticing persistently high serum concentrations of valproic acid. The relatively low molecular weight (144 Daltons) and low volume of distribution of valproic acid suggest a potential benefit from hemodialysis, especially at a serum concentration of >850 mg/L or in the event of a shock. In this patient, mentation and stability status were improved after hemodialysis. Hemodialysis appears to be the last treatment resort for severe valproic acid poisoning.
丙戊酸中毒的后果可能从轻微到致命，这取决于其在体内的浓度。关于将血液透析作为最终治疗手段的使用，仅有罕见的病例报告，几乎没有已知的对照研究。我们报告了纽约市布鲁克林区第一健康/跨信仰校区一例罕见的丙戊酸中毒病例，该病例需要进行插管和血液透析。患者为一名47岁男性，既往有癫痫 disorder、多物质使用 disorder、精神分裂症和胃食管反流病（GERD）病史，因故意过量服用60片其家中开具的德巴金缓释片500mg（约30g）丙戊酸而被送往医疗急诊科（ED）。患者的其他门诊药物包括丙戊酸、曲唑酮、对乙酰氨基酚、法莫替丁、氟西汀、叶酸、氢化可的松 - 芦荟、多种维生素、尼古丁聚丙烯酸酯和硫胺素。患者的初始血液检查显示丙戊酸、氨、乙醇和乳酸水平升高。在ED入院约6小时后，患者变得嗜睡，使用非重复呼吸面罩时血氧饱和度降至74%，在注意到丙戊酸血清浓度持续升高后，需要进行插管和血液透析。丙戊酸相对较低的分子量（道尔顿）和低分布容积表明血液透析可能有益，特别是在血清浓度>850mg/L或发生休克的情况下。在该患者中,血液透析后精神状态和稳定状况得到改善。血液透析似乎是严重丙戊酸中毒的最终治疗手段。
