A case of acute bromvalerylurea intoxication that was successfully treated with direct hemoperfusion

Bromvalerylurea is included in over-the-counter analgesics and is known to cause chronic bromism. Patients can also present acute intoxication because of suicide attempts. The treatment consists of drug cessation and intravenous drip with furosemide. Few reports have described the efficacy of blood purification therapy in a critical case. We report a 21-year-old Japanese woman who was admitted to our hospital in an unconscious state after she had taken 388 tablets of NARON ACE. She was intubated and high flow continuous hemodiafiltration was initiated because her blood pressure remained low, despite continuous intravenous drip infusion. To remove unknown drugs, direct hemoperfusion was performed twice. NARON ACE contains bromvalerylurea, ibuprofen, ethenzamide, and anhydrous caffeine; only the amount of bromvalerylurea was thought to exceed a lethal dose. The plasma concentrations of bromvalerylurea on the first, second, third, and fourth days were 118.9, 45.1, 30.2, and 12.6 μg/mL, respectively. Her level of consciousness improved on the third day and she was extubated. She became stable and was transferred to the psychiatric department to continue medication on day 14. Her clinical course improved, and she was discharged on day 89. In a potentially fatal case, direct hemoperfusion combined with intravenous drip should be considered.