title: [Successful hemodialysis for life-threatening carbamazepine drug overdose: Case-based introduction of new guidelines].
abstract: BACKGROUND
  Over the last decade, there has been a paradigm shift in the extracorporeal treatment of intoxications. The availability of new treatment options, especially new membranes has led to a decrease in the use of techniques like charcoal hemoperfusion, once considered the gold standard to eliminate highly protein bound substances.
  The EXtracorporeal Treatments In Poisoning (EXTRIP) workgroup is a collaborative international effort of pharmacologists, toxicologists, critical care physicians, and nephrologists that is reviewing all available evidence in extracorporeal procedures for the treatment of poisonings in a standardized way to distill treatment recommendations for the physician at the bedside. One of the first available EXTRIP guidelines summarizes treatment recommendations for severe carbamazepine intoxications.
  
  
  METHODS
  We report the case of a 43-year-old Caucasian woman with who ingested about 21 g carbamazepine in a suicidal attempt together with alcohol. Combining gastroscopic removal of carbamazepine and multiple dose activated charcoal with intermittent high-flux hemodialysis lowered the initial carbamazepine level of 56.5 mg/l (47 mg/l before dialysis) to 25 mg/l. The patient, who initially required mechanical ventilation could be transferred to the psychiatric ward 24 h after ICU admission.
authors: Zentrum Innere Medizin, Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland.
authors: N
authors: N
authors: Drick
authors: Zentrum Innere Medizin, Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland.
authors: M
authors: M
authors: Patecki
authors: Zentrum Innere Medizin, Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland.
authors: V
authors: V
authors: Arelin
authors: Zentrum Innere Medizin, Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland.
authors: J J
authors: JJ
authors: Schmidt
authors: Zentrum Innere Medizin, Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland.
authors: O
authors: O
authors: Wahl
authors: Zentrum Innere Medizin, Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland. kielstein@yahoo.com.
authors: J T
authors: JT
authors: Kielstein
mesh_terms: D000328:Adult; D002220:Carbamazepine / Q000493:pharmacokinetics / Q000506:poisoning*; D003131:Combined Modality Therapy; D003422:Critical Care; D003692:Delayed-Action Preparations; D062787:Drug Overdose / Q000628:therapy*; D000431:Ethanol / Q000506:poisoning; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008657:Metabolic Clearance Rate / Q000502:physiology; D011175:Positive-Pressure Respiration; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D013406:Suicide, Attempted
chemical_list: D003692:Delayed-Action Preparations; D002220:Carbamazepine; D000431:Ethanol
keywords: Dibenzazepines; Hemodialysis; Poisoning; Renal replacement therapy; Therapeutic drug monitoring