Pediatric nephrology : journal of the International Pediatric Nephrology Association
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Toxic ingestion of valproic acid is difficult to treat as no antidote exists and hemodialysis has been considered ineffective for clearance due to high protein binding of this drug. Recent reports suggest that protein binding of valproic acid is saturated at toxic levels, thereby allowing for removal of free drug by extracorporeal circuits. We describe our experiences in two children with toxic blood levels of valproic acid, in whom we were able to achieve effective clearances by extracorporeal removal without charcoal hemoperfusion. ⋯ In a younger 18-month-old child with initial levels of 922 microg/ml, k(el) was fivefold higher at 0.25/h during conventional hemodialysis, compared with 0.05/h after dialysis. Similarly, the drug half-life was 2.9 h during dialysis and 12.9 h after dialysis. Both conventional hemodialysis and high-flux hemodiafiltration are effective treatment modalities that should be offered to all pediatric patients with valproic acid ingestion and neurological compromise.