Enhanced elimination

Multiple-dose activated charcoal

Multiple-dose activated charcoal has been shown to reduce peak serum valproate concentration and reduce its elimination half-life. Consider multiple-dose activated charcoal for ingestions of more than 500 mg/kg.

If considering the use of multiple-dose activated charcoal, seek advice from a clinical toxicologist. Patients must be alert, cooperative and able to protect their airway to drink a dose of activated charcoal, or be intubated and receive activated charcoal via a nasogastric or orogastric tube—confirm correct placement of the nasogastric or orogastric tube beforehand.

Extracorporeal elimination

Consider haemodialysis early in patients with life-threatening sodium valproate poisoning—seek advice from a clinical toxicologist. Indications for haemodialysis include:

• serum valproate concentration of more than 1000 mg/L (7000 micromol/L)
• signs of severe toxicity—severe metabolic acidosis with a serum pH less than 7.10, cerebral oedema or shock.

For more information on haemodialysis, see here.