The Experts below are selected from a list of 243 Experts worldwide ranked by ideXlab platform
Dra Uges - One of the best experts on this subject based on the ideXlab platform.
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Valproic Acid toxicokinetics serial hemodialysis and hemoperfusion
Therapeutic Drug Monitoring, 1999Co-Authors: Ejf Franssen, G G Van Essen, A T Portman, G Go, Coen A. Stegeman, Dra UgesAbstract:The toxicity and pharmacokinetic properties of a drug determine whether hemodialysis and/or hemoperfusion are indicated in acute intoxications. Valproic Acid is considered unremovable by hemodialysis because of the high protein binding of 90%-95%. A 27-year-old male with a history of seizures was admitted to the emergency room because of coma, hypernatriemia, and respiratory failure caused by an intoxication with a large dose of Valproic Acid. At admission; the plasma Valproic Acid level was 1414 mg/L (9.9 mmol/L) (therapeutic range: 50-100 mg/L (350-700 umol/L). The anion gap was 26 mmol/L (normal <12-14 mmol/L) and corresponded fairly well with this Valproic Acid level. Because of the potential toxicity of this high Valproic Acid level serial hemodialysis and hemoperfusion was performed. The first session was done with a charcoal column and the second session with a resin column. The patient recovered during the course of treatment. The Valproic Acid plasma clearances during treatment were: 80 mL/min (hemodialysis); 40 mL/min (hemoperfusion by charcoal) and 80 mL/min (hemoperfusion by resin, only in the first hour). The protein binding of Valproic Acid in plasma was only 32% at the start and was 54% at the end of the two sessions. In this specific case of a severe Valproic Acid intoxication, saturated protein binding resulted in an increased fraction of unbound Valproic Acid. This made hemodialysis an effective treatment, while hemoperfusion was relatively less effective because of saturation of the column. In conclusion, the toxicokinetics of valproate are quite different from the pharmacokinetics at therapeutic levels. The anion gap and protein binding are important parameters in toxicokinetics.
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Valproic Acid toxicokinetics: serial hemodialysis and hemoperfusion.
Therapeutic drug monitoring, 1999Co-Authors: Ejf Franssen, A T Portman, Coen A. Stegeman, G. G. Van Essen, J. De Jong, Dra UgesAbstract:The toxicity and pharmacokinetic properties of a drug determine whether hemodialysis and/or hemoperfusion are indicated in acute intoxications. Valproic Acid is considered unremovable by hemodialysis because of the high protein binding of 90%-95%. A 27-year-old male with a history of seizures was admitted to the emergency room because of coma, hypernatriemia, and respiratory failure caused by an intoxication with a large dose of Valproic Acid. At admission, the plasma Valproic Acid level was 1414 mg/L (9.9 mmol/L) (therapeutic range: 50-100 mg/L (350-700 micromol/ L). The anion gap was 26 mmol/L (normal
Ejf Franssen - One of the best experts on this subject based on the ideXlab platform.
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Valproic Acid toxicokinetics serial hemodialysis and hemoperfusion
Therapeutic Drug Monitoring, 1999Co-Authors: Ejf Franssen, G G Van Essen, A T Portman, G Go, Coen A. Stegeman, Dra UgesAbstract:The toxicity and pharmacokinetic properties of a drug determine whether hemodialysis and/or hemoperfusion are indicated in acute intoxications. Valproic Acid is considered unremovable by hemodialysis because of the high protein binding of 90%-95%. A 27-year-old male with a history of seizures was admitted to the emergency room because of coma, hypernatriemia, and respiratory failure caused by an intoxication with a large dose of Valproic Acid. At admission; the plasma Valproic Acid level was 1414 mg/L (9.9 mmol/L) (therapeutic range: 50-100 mg/L (350-700 umol/L). The anion gap was 26 mmol/L (normal <12-14 mmol/L) and corresponded fairly well with this Valproic Acid level. Because of the potential toxicity of this high Valproic Acid level serial hemodialysis and hemoperfusion was performed. The first session was done with a charcoal column and the second session with a resin column. The patient recovered during the course of treatment. The Valproic Acid plasma clearances during treatment were: 80 mL/min (hemodialysis); 40 mL/min (hemoperfusion by charcoal) and 80 mL/min (hemoperfusion by resin, only in the first hour). The protein binding of Valproic Acid in plasma was only 32% at the start and was 54% at the end of the two sessions. In this specific case of a severe Valproic Acid intoxication, saturated protein binding resulted in an increased fraction of unbound Valproic Acid. This made hemodialysis an effective treatment, while hemoperfusion was relatively less effective because of saturation of the column. In conclusion, the toxicokinetics of valproate are quite different from the pharmacokinetics at therapeutic levels. The anion gap and protein binding are important parameters in toxicokinetics.
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Valproic Acid toxicokinetics: serial hemodialysis and hemoperfusion.
Therapeutic drug monitoring, 1999Co-Authors: Ejf Franssen, A T Portman, Coen A. Stegeman, G. G. Van Essen, J. De Jong, Dra UgesAbstract:The toxicity and pharmacokinetic properties of a drug determine whether hemodialysis and/or hemoperfusion are indicated in acute intoxications. Valproic Acid is considered unremovable by hemodialysis because of the high protein binding of 90%-95%. A 27-year-old male with a history of seizures was admitted to the emergency room because of coma, hypernatriemia, and respiratory failure caused by an intoxication with a large dose of Valproic Acid. At admission, the plasma Valproic Acid level was 1414 mg/L (9.9 mmol/L) (therapeutic range: 50-100 mg/L (350-700 micromol/ L). The anion gap was 26 mmol/L (normal
Ludo Willems - One of the best experts on this subject based on the ideXlab platform.
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meropenem Valproic Acid interaction in patients with cefepime associated status epilepticus
American Journal of Health-system Pharmacy, 2007Co-Authors: Isabel Spriet, Wouter Meersseman, Elke De Troy, Alexander Wilmer, Minne Casteels, Ludo WillemsAbstract:Purpose. Two case reports of rapid decreases in Valproic Acid levels after initiation of meropenem in patients who developed new-onset seizure activity during treatment with cefepime are presented. Summary. A 60-year-old Caucasian woman with myelodysplasia was transferred to the medical intensive care unit (MICU) on day 11 of her hospitalization. Cefepime was given as empiric therapy for febrile neutropenia. Pulmonary invasive aspergillosis was diagnosed. On day 16 of hospitalization, epileptic activity was confirmed. Valproic Acid was initiated. Cefepime was discontinued and meropenem was initiated for treatment of cefepime-resistant pneumonia. Serum Valproic Acid levels decreased to subtherapeutic levels within 24 hours. Meropenem was discontinued and ceftazidime was started on day 22; serum Valproic Acid levels gradually increased but never reached therapeutic levels again. The patient died of intractable invasive aspergillosis on day 33. A 54-year-old Caucasian man with myelodysplasia was admitted to the MICU for nonconvulsive status epilepticus. Ten days before admission, cefepime had been started empirically for the treatment of neutropenic fever. One day before MICU admission, Valproic Acid was initiated as treatment for status epilepticus. The next day, serum Valproic Acid levels were therapeutic; cefepime was switched to mero penem. Serum Valproic Acid levels decreased within 24 hours and phenytoin was added. On day 4, the patient’s serum Valproic Acid levels decreased further and meropenem was discontinued. Although the Valproic Acid dosage was increased, Valproic Acid levels did not return to the therapeutic range. The patient died on day 11. Conclusion. Following cefepime therapy, a clinically important interaction between meropenem and Valproic Acid occurred in two critically ill patients with new-onset status epilepticus.
Coen A. Stegeman - One of the best experts on this subject based on the ideXlab platform.
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Valproic Acid toxicokinetics serial hemodialysis and hemoperfusion
Therapeutic Drug Monitoring, 1999Co-Authors: Ejf Franssen, G G Van Essen, A T Portman, G Go, Coen A. Stegeman, Dra UgesAbstract:The toxicity and pharmacokinetic properties of a drug determine whether hemodialysis and/or hemoperfusion are indicated in acute intoxications. Valproic Acid is considered unremovable by hemodialysis because of the high protein binding of 90%-95%. A 27-year-old male with a history of seizures was admitted to the emergency room because of coma, hypernatriemia, and respiratory failure caused by an intoxication with a large dose of Valproic Acid. At admission; the plasma Valproic Acid level was 1414 mg/L (9.9 mmol/L) (therapeutic range: 50-100 mg/L (350-700 umol/L). The anion gap was 26 mmol/L (normal <12-14 mmol/L) and corresponded fairly well with this Valproic Acid level. Because of the potential toxicity of this high Valproic Acid level serial hemodialysis and hemoperfusion was performed. The first session was done with a charcoal column and the second session with a resin column. The patient recovered during the course of treatment. The Valproic Acid plasma clearances during treatment were: 80 mL/min (hemodialysis); 40 mL/min (hemoperfusion by charcoal) and 80 mL/min (hemoperfusion by resin, only in the first hour). The protein binding of Valproic Acid in plasma was only 32% at the start and was 54% at the end of the two sessions. In this specific case of a severe Valproic Acid intoxication, saturated protein binding resulted in an increased fraction of unbound Valproic Acid. This made hemodialysis an effective treatment, while hemoperfusion was relatively less effective because of saturation of the column. In conclusion, the toxicokinetics of valproate are quite different from the pharmacokinetics at therapeutic levels. The anion gap and protein binding are important parameters in toxicokinetics.
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Valproic Acid toxicokinetics: serial hemodialysis and hemoperfusion.
Therapeutic drug monitoring, 1999Co-Authors: Ejf Franssen, A T Portman, Coen A. Stegeman, G. G. Van Essen, J. De Jong, Dra UgesAbstract:The toxicity and pharmacokinetic properties of a drug determine whether hemodialysis and/or hemoperfusion are indicated in acute intoxications. Valproic Acid is considered unremovable by hemodialysis because of the high protein binding of 90%-95%. A 27-year-old male with a history of seizures was admitted to the emergency room because of coma, hypernatriemia, and respiratory failure caused by an intoxication with a large dose of Valproic Acid. At admission, the plasma Valproic Acid level was 1414 mg/L (9.9 mmol/L) (therapeutic range: 50-100 mg/L (350-700 micromol/ L). The anion gap was 26 mmol/L (normal
A T Portman - One of the best experts on this subject based on the ideXlab platform.
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Valproic Acid toxicokinetics serial hemodialysis and hemoperfusion
Therapeutic Drug Monitoring, 1999Co-Authors: Ejf Franssen, G G Van Essen, A T Portman, G Go, Coen A. Stegeman, Dra UgesAbstract:The toxicity and pharmacokinetic properties of a drug determine whether hemodialysis and/or hemoperfusion are indicated in acute intoxications. Valproic Acid is considered unremovable by hemodialysis because of the high protein binding of 90%-95%. A 27-year-old male with a history of seizures was admitted to the emergency room because of coma, hypernatriemia, and respiratory failure caused by an intoxication with a large dose of Valproic Acid. At admission; the plasma Valproic Acid level was 1414 mg/L (9.9 mmol/L) (therapeutic range: 50-100 mg/L (350-700 umol/L). The anion gap was 26 mmol/L (normal <12-14 mmol/L) and corresponded fairly well with this Valproic Acid level. Because of the potential toxicity of this high Valproic Acid level serial hemodialysis and hemoperfusion was performed. The first session was done with a charcoal column and the second session with a resin column. The patient recovered during the course of treatment. The Valproic Acid plasma clearances during treatment were: 80 mL/min (hemodialysis); 40 mL/min (hemoperfusion by charcoal) and 80 mL/min (hemoperfusion by resin, only in the first hour). The protein binding of Valproic Acid in plasma was only 32% at the start and was 54% at the end of the two sessions. In this specific case of a severe Valproic Acid intoxication, saturated protein binding resulted in an increased fraction of unbound Valproic Acid. This made hemodialysis an effective treatment, while hemoperfusion was relatively less effective because of saturation of the column. In conclusion, the toxicokinetics of valproate are quite different from the pharmacokinetics at therapeutic levels. The anion gap and protein binding are important parameters in toxicokinetics.
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Valproic Acid toxicokinetics: serial hemodialysis and hemoperfusion.
Therapeutic drug monitoring, 1999Co-Authors: Ejf Franssen, A T Portman, Coen A. Stegeman, G. G. Van Essen, J. De Jong, Dra UgesAbstract:The toxicity and pharmacokinetic properties of a drug determine whether hemodialysis and/or hemoperfusion are indicated in acute intoxications. Valproic Acid is considered unremovable by hemodialysis because of the high protein binding of 90%-95%. A 27-year-old male with a history of seizures was admitted to the emergency room because of coma, hypernatriemia, and respiratory failure caused by an intoxication with a large dose of Valproic Acid. At admission, the plasma Valproic Acid level was 1414 mg/L (9.9 mmol/L) (therapeutic range: 50-100 mg/L (350-700 micromol/ L). The anion gap was 26 mmol/L (normal
