title: Successful treatment of carbamazepine poisoning with hemodialysis: a case report and review of the literature.
abstract: A 48-year-old man was brought to the emergency room after ingesting an unknown amount of carbamazepine. He was unconscious and not responding to the noxious stimuli. He was intubated and was placed on mechanical ventilation because of respiratory insufficiency. Primary detoxification was performed with a gastric lavage and charcoal instillation. His serum carbamazepine level was 25.6 mcg/mL at the time of admission. His computed tomography of the brain was normal. He was managed conservatively but there was no improvement in his neurological status in the next 24 hours. Serum carbamazepine level was repeated and reported to be 28.3 mcg/mL. As there was no improvement in his sensorium and the serum carbamazepine levels remained persistently high, extracorporeal removal of carbamazepine was attempted. As the facility to carry out hemoperfusion was not available immediately, the decision to initiate hemodialysis was taken. After 3 sessions of hemodialysis, his sensorium improved markedly and the carbamazepine level at this time was within the therapeutic range. He was discharged after psychiatry consultation and counseling. We review the literature regarding extra corporeal techniques for the removal of carbamazepine and discuss them in this article.
authors.affiliation: Department of Nephrology, Sri Ramachandra Medical College, Chennai, India. prabahar76@yahoo.co.in
authors.forename: Murugesan
authors.initials: M
authors.lastname: Ram Prabahar
authors.forename: Kalidindi
authors.initials: K
authors.lastname: Raja Karthik
authors.forename: Mohini
authors.initials: M
authors.lastname: Singh
authors.forename: Raja Beem
authors.initials: RB
authors.lastname: Singh
authors.forename: Sudhagar
authors.initials: S
authors.lastname: Singh
authors.forename: Jayachandran
authors.initials: J
authors.lastname: Dhamodharan
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics*; D002220:Carbamazepine / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives / Q000493:pharmacokinetics*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000628:therapy*; D005260:Female; D006801:Humans; D006435:Renal Dialysis; D013997:Time Factors
chemical_list: D018712:Analgesics, Non-Narcotic; D002220:Carbamazepine; C012227:carbamazepine epoxide