Issue: 2004 > October > editorial

Enhanced extracorporeal elimination of valproic acid in overdose

R. Engbersen, C. Kramers


The treatment of the poisoned patient has been based on
three main approaches: use of supportive nonspecific
therapy, if available administration of antidotes and
removal of the offending drug from the body. Gastric
lavage and binding of nonabsorbed drug by activated
charcoal are often used in an attempt to eliminate the
intoxicating agent from the body. In addition, elimination
of already absorbed drug can sometimes be enhanced by the induction of brisk diuresis coupled to manipulation
of urine pH (e.g. alkalinise for salicylates) or applying
extracorporeal techniques such as haemodialysis,
haemofiltration or haemoperfusion. In this issue of
the journal Meek <i>et al.</i> describe the application of haemodialysis in a patient with severe valproic acid (VPA) overdose and demonstrate an increased elimination after the start of haemodialysis.