Journal of Clinical Toxicology
Open Access

Abstract

Rapid Rescue from Hyperammonemic Coma After Valproic Acid Poisoning: Dual Therapy with Continuous Renal Replacement Therapy and L-carnitine Supplementation

Breeanna Murphy, Kenneth Guillotte and Shyam Kiran Gandam Venkata

Acute hyperammonemia following valproic acid poisoning is a medical emergency which can lead to irreversible neurological damage, metabolic derangements, and liver failure. Although treatment with renal replacement therapy and L-carnitine supplementation is well documented, scant literature is available in using both modalities together. Case details: We report a case with rapid rescue from life threatening hyperammonemic coma secondary to intentional valproic acid overdose by using dual therapy of continuous veno-venous hemodialysis in combination with L-carnitine supplementation. The patient presented with rapid decline in mental status requiring intubation. The patient’s condition rapidly improved upon initiation of treatment, and there were no apparent sequelae from his overdose at the time of discharge. Discussion: Treatment of life threatening valproic acid toxicity must clear valproic acid and ammonia from serum, curb the production of ammonia, control fluid balance, and maintain appropriate serum electrolyte levels. Prompt initiation of dual therapy with renal replacement therapy and L-carnitine supplementation facilitated a swift and complete recovery in this patient.