Intoxication grave à l'acide valproïque : place du traitement antidotique et de l'épuration extracorporelle

Valproic acid, a frequently prescribed antiepileptic drug, may be responsible of severe poisonings. Following the description of a case of valproic acid poisoning resulting in a peak plasma concentration of 1,437 mg/L, management of severe valproic acid intoxications is reviewed. Definitive recommendations remain sparse. Several studies suggested the interest of l-carnitine; however, no consensus about its regimen exists. In addition, extracorporeal techniques appeared in literature useful to enhance valproic acid elimination, although none among these techniques was more effective. Thus, randomized controlled trials are warranted to definitively assess the clinical interest of l-carnitine as well as extracorporeal drug removal enhancement on the final poisoning outcome.