title: Severe carbamazepine intoxication unresponsive to albumin-enhanced continuous venovenous hemodiafiltration with low dialysate flow.
abstract: Carbamazepine (CBZ) intoxication can be associated with severe toxicity, including neurological and cardio-respiratory abnormalities. Highly protein-bound, CBZ is not removed efficiently through conventional hemodialysis. Charcoal hemoperfusion is the most effective extracorporeal elimination therapy for CBZ intoxication. Recent reports have indicated that continuous venovenous hemodiafiltration (CVVHDF), albumin-enhanced continuous venovenous hemodialysis, high-flux hemodialysis and plasma exchange can be as effective as charcoal hemoperfusion. In contrast to recent reports, which demonstrated the effectiveness of CVVHDF with high dialysate flow in CBZ intoxication, we observed that serum CBZ level was decreased minimally by albumin-enhanced CVVHDF with low dialysate flow. Therefore, albumin-enhanced CVVHDF with high dialysate flow should be considered in severe CBZ intoxication, if hemoperfusion is unavailable because of the lack of facilities or if it cannot be performed.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea; St. Vincent's Hospital, Suwon, Korea.
authors.forename: Young K
authors.initials: YK
authors.lastname: Chung
authors.forename: Kyung Y
authors.initials: KY
authors.lastname: Chang
authors.forename: Hoon S
authors.initials: HS
authors.lastname: Park
authors.forename: Mi-Hee
authors.initials: MH
authors.lastname: Kim
authors.forename: Kang-Min
authors.initials: KM
authors.lastname: Lee
authors.forename: Tae-Seok
authors.initials: TS
authors.lastname: Lim
authors.forename: Hyung W
authors.initials: HW
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000418:Albumins; D000927:Anticonvulsants / Q000506:poisoning*; D002220:Carbamazepine / Q000506:poisoning*; D002606:Charcoal; D015314:Dialysis Solutions; D062787:Drug Overdose / Q000628:therapy*; D017583:Hemodiafiltration / Q000379:methods*; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D008297:Male
chemical_list: D000418:Albumins; D000927:Anticonvulsants; D015314:Dialysis Solutions; D002606:Charcoal; D002220:Carbamazepine
keywords: Carbamazepine; continuous venovenous hemodiafiltration; hemoperfusion