Dialysis with bipolar affective disorder: experience of competing treatments

The interaction of several serious illnesses presents considerable difficulty for both clinicians and patients, no matter what the coexisting diseases are. This results in huge anxiety for patients and worsens the difficulties understanding the risks and benefits of the treatment of each disorder. The authors present the clinical scenario where dialysis was commenced while sodium valproate was being taken for bipolar affective disorder, demonstrating the interface between bipolar affective disorder and renal failure and how their treatments caused deterioration in the comorbid condition. This case challenges accepted wisdom regarding the effects of dialysis on the sodium valproate levels in the body and discusses key clinical management issues.