Acute valproate intoxication: biochemical investigations and hemodialysis treatment

A 20-year-old female was comatose for several days after intoxication with 75 g sodium valproate (VPA). She was successfully treated with hemodialysis, hemoperfusion, i.v. infusion of glucose, and given intensive care. Although a peak serum VPA of 2120 micrograms/ml (14720 microM) was registered 8 1/2 h after drug intake, no definite drug-related hepatotoxic or thrombocytopenic effects were seen. The only signs of organotoxicity were slight increases in serum amylase and a transient proteinuria. Further acute biochemical alterations were a decrease in serum calcium, an increase in plasma ammonia as well as in serum propionate, and elevated urinary excretions of adipic and suberic acid. Analysis of amino acids in serum revealed a stable increased level of glycine.