Carbamazepine Intoxication Unresponsive to Continuous Venovenous Hemodiafiltration = Carbamazepine Intoxication Unresponsive to Continuous Venovenous Hemodiafiltration

다국어 초록 (Multilingual Abstract)

Carbamazepine (CBZ) intoxication can be associated with severe toxicity. Highly protein-bounded, CBZ is not removed efficiently through conventional hemodialysis. 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 cannot be performed. Introduction: Carbamazepine is commonly used as an anticonvulsant agent. Due to the diverse availability of CBZ, the incidence of accidental and intentional poisoning is high and there is no specific antidote for CBZ intoxication. Recent studies have demonstrated that continuous venovenous hemodiafiltration and albumin-enhanced CVVHD with high dialysate flow can also be effectively used to treat severe CBZ intoxication Case Report: A 17-year-old, 57-kg boy with depressive disorder presented with three generalized tonic clonic seizures between which there is no recovery of consciousness. he had taken 18,000 mg (60 tablets) of controlled-release CBZ (300 mg). His serum CBZ level was found to be 36 μg/mL. He could not receive multiple-dose activated charcoal because of severe ileus. We started albumin-enhanced CVVHDF 48 hours after ingestion. but He remained unconscious although we treated him with albumin-enhanced CVVHDF for 20 hours. so We made the decision to convert to charcoal hemoperfusion. Serum CBZ levels were measured before and after the procedures. Reduction ratio and half-life (T½) of the serum CBZ level during albumin-enhanced CVVHDF (20 hours) were 24.2%and 41.4 hours. Reduction ratio and T½during charcoal hemoperfusion for 3 hours were 43.7% and 3.5 hours. The patient recovered without any neurological sequelae. Discussions: It is well known that charcoal hemoperfusion is standard care in severe CBZ intoxication, charcoal hemoperfusion cannot be performed in many cases because of the lack of facilities. In case that charcoal hemoperfusion is unavailable or cannot be performed in severe CBZ intoxication, albumin-enhanced CVVHDF with high dialysate flow should be considered.