Valproic Acid Poisoning

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General Recommendation

  • ECTR is recommended in severe VPA poisoning (1D)



ECTR is recommended if any of the following is present:

  • If the [VPA] is > 1300 mg/L (9000 μ mol/L) (1D)

  • If shock is present (1D)

  • If cerebral edema is present (1D)


ECTR is suggested if any of the following is present:

  • If the [VPA] is > 900 mg/L (6250 μ mol/L) (2D)

  • If coma or respiratory depression requiring mechanical ventilation is present (2D)

  • If acute hyperammonemia is present (2D)

  • If pH is < 7.10 (2D)


Cessation of ECTR is indicated if any of the following is present: 

  • Clinical improvement is apparent (1D)

  • [VPA] is between 50 and 100 mg/L (350 – 700 μ mol/L) (2D)


Choice of ECTR:

  • Intermittent hemodialysis is the preferred ECTR in VPA poisoning (1D)

  • If hemodialysis is not available, both intermittent hemoperfusion (1D) and CRRT (2D) are acceptable alternatives 


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