Enhanced extracorporeal elimination of valproic acid in overdose

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 et al. describe the application of haemodialysis in a patient with severe valproic acid (VPA) overdose and demonstrate an increased elimination after the start of haemodialysis.