| [ Summary ] |
We performed direct hemoperfusion (DHP) with activated charcoal for a patient after ingestion of 18g of valproate (VPA) and obtained progressive recovery of consciousness with decreasing plasma VPA concentrations. The half-life (t1/2) of VPA was 4.4 hours before the procedure and 1.8 hours during the procedure. DHP with activated charcoal was an effective treatment for the patient with a VPA over dose and in a coma. Analysis of urine samples before DHP demonstrated large amounts of VPA-glucuronide and lactate but Beta-keto-VPA, a major mitochondrial metabolite, was not detected. After DHP, when the plasma VPA level decreased, Beta-keto-VPA appeared in significantly. On the other hand, levels of VPA-glucuronide and lactate decreased markedly. The onset of coma probably was induced by disturbances of brain mitochondrial function resulting from beta-oxidation due to a VPA overdose. |