The Use of Carnitine Rather than Renal Replacement Therapy for Sodium Valproate Poisoning

Sodium valproate (VPA) is a salt of 2-propylpentanoic acid, an anticonvulsant drug which has been in use for some three decades now. It is prescribed for the prevention of many types of partial and generalised seizure. More recently, its use has increased in other conditions such as chronic pain syndromes, the prophylaxis and treatment of migraine and some psychiatric conditions such as bipolar and schizoaffective disorders.1 Acute VPA toxicity usually results in mild, self-limited symptoms, but occasionally can lead to life-threatening hepatic and central nervous system poisoning. Therapies to rescue such patients include ventilator and cardiovascular support and extracorporeal removal of the drug. There are also increasing reports of the use of L-carnitine in acute VPA overdose. We present a case in which this therapy was successfully used as an alternative to haemodiafiltration.