Repeat charcoal hemoperfusion treatments in life threatening carbamazepine overdose.
A 16-month-old female experienced a massive carbamazepine ingestion resulting in a peak serum carbamazepine concentration of 55 microg/ml. Clinical manifestations included generalized seizures, coma, shock, and gastrointestinal hypomotility. Gut decontamination was attempted using multiple-dose activated charcoal and cathartics. Because of the severity of illness, charcoal hemoperfusion was initiated. The patient underwent three sessions of charcoal hemoperfusion, each utilizing a fresh cartridge, with one session immediately following the other. Serum carbamazepine and carbamazepine-10,11-epoxide concentrations decreased from 54 microg/ml to 23 microg/ml, and 30 microg/ml to 17 microg/ml, respectively, during charcoal hemoperfusion. There were no complications. The patient recovered completely and was discharged on the 4th hospital day. Charcoal hemoperfusion should be considered for life-threatening carbamazepine intoxication, especially when drug-induced gastrointestinal hypomotility prevents elimination via the gut.
Deshpande
G
G
Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Meert
K L
KL
Valentini
R P
RP
D002220:Carbamazepine / Q000097:blood / Q000506:poisoning*; D002606:Charcoal / Q000008:administration & dosage* / Q000627:therapeutic use*; D062787:Drug Overdose / Q000097:blood / Q000628:therapy; D005260:Female; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D007223:Infant; D013997:Time Factors
D002606:Charcoal; D002220:Carbamazepine