Tank J E, Palmer B F
Internal Medicine Division of Nephrology, University of Texas Southwestern Medical Center, Dallas 75235.
Am J Kidney Dis. 1993 Aug;22(2):341-4. doi: 10.1016/s0272-6386(12)70329-3.
There is little published experience with the extracorporeal treatment of valproic acid overdose, although the pharmacokinetic properties of valproic acid suggest a potential role for hemodialysis and/or hemoperfusion. At therapeutic concentrations valproic acid is highly protein bound, but at the higher concentrations seen in the overdose setting binding sites become saturated and free valproic acid should be subject to removal by hemodialysis. We report the case of a patient with serious toxicity secondary to valproic acid overdose who was successfully treated with a combination of hemodialysis and hemoperfusion. With this treatment the half-life of valproic acid was reduced from a predialysis level of 13 hours to 1.7 hours, with rapid lowering of valproic acid levels and dramatic clinical improvement. Based on our experience in this patient and a review of previously reported cases, hemodialysis should be considered in the treatment of valproic acid overdose.
尽管丙戊酸的药代动力学特性提示血液透析和/或血液灌流可能发挥作用，但关于丙戊酸过量体外治疗的公开经验很少。在治疗浓度下，丙戊酸与蛋白质高度结合，但在过量情况下所见的较高浓度时，结合位点会饱和，游离丙戊酸应可通过血液透析清除。我们报告了一例丙戊酸过量继发严重毒性的患者，该患者通过血液透析和血液灌流联合治疗成功治愈。通过这种治疗，丙戊酸的半衰期从透析前的13小时降至1.7小时，丙戊酸水平迅速降低，临床症状显著改善。基于我们对该患者的经验以及对既往报道病例的回顾，在丙戊酸过量的治疗中应考虑血液透析。
