دورية أكاديمية
Valproic acid toxicokinetics: serial hemodialysis and hemoperfusion.
| العنوان: | Valproic acid toxicokinetics: serial hemodialysis and hemoperfusion. |
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| المؤلفون: | Franssen EJ; Department of Pharmacy, Groningen University Hospital, The Netherlands., van Essen GG, Portman AT, de Jong J, Go G, Stegeman CA, Uges DR |
| المصدر: | Therapeutic drug monitoring [Ther Drug Monit] 1999 Jun; Vol. 21 (3), pp. 289-92. |
| نوع المنشور: | Case Reports; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 7909660 Publication Model: Print Cited Medium: Print ISSN: 0163-4356 (Print) Linking ISSN: 01634356 NLM ISO Abbreviation: Ther Drug Monit Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Hagerstown, MD : Lippincott Williams & Wilkins Original Publication: [New York] Raven Press. |
| مواضيع طبية MeSH: | Hemoperfusion* , Renal Dialysis*, Anticonvulsants/*poisoning , Valproic Acid/*poisoning, Adult ; Anticonvulsants/pharmacokinetics ; Drug Overdose ; Humans ; Male ; Valproic Acid/pharmacokinetics |
| مستخلص: | The toxicity and pharmacokinetic properties of a drug determine whether hemodialysis and/or hemoperfusion are indicated in acute intoxications. Valproic acid is considered unremovable by hemodialysis because of the high protein binding of 90%-95%. A 27-year-old male with a history of seizures was admitted to the emergency room because of coma, hypernatriemia, and respiratory failure caused by an intoxication with a large dose of valproic acid. At admission, the plasma valproic acid level was 1414 mg/L (9.9 mmol/L) (therapeutic range: 50-100 mg/L (350-700 micromol/ L). The anion gap was 26 mmol/L (normal <12-14 mmol/L) and corresponded fairly well with this valproic acid level. Because of the potential toxicity of this high valproic acid level serial hemodialysis and hemoperfusion was performed. The first session was done with a charcoal column and the second session with a resin column. The patient recovered during the course of treatment. The valproic acid plasma clearances during treatment were: 80 mL/min (hemodialysis); 40 mL/min (hemoperfusion by charcoal) and 80 mL/min (hemoperfusion by resin, only in the first hour). The protein binding of valproic acid in plasma was only 32% at the start and was 54% at the end of the two sessions. In this specific case of a severe valproic acid intoxication, saturated protein binding resulted in an increased fraction of unbound valproic acid. This made hemodialysis an effective treatment, while hemoperfusion was relatively less effective because of saturation of the column. In conclusion, the toxicokinetics of valproate are quite different from the pharmacokinetics at therapeutic levels. The anion gap and protein binding are important parameters in toxicokinetics. |
| المشرفين على المادة: | 0 (Anticonvulsants) 614OI1Z5WI (Valproic Acid) |
| تواريخ الأحداث: | Date Created: 19990612 Date Completed: 19990803 Latest Revision: 20190905 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1097/00007691-199906000-00005 |
| PMID: | 10365638 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 0163-4356 |
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| DOI: | 10.1097/00007691-199906000-00005 |