Charcoal hemoperfusion via a continuous venovenous hemofiltration circuit to treat carbamazepine overdose

Milonovich, Lisa M.; Headrick, C. L.; Seikaly, Mouin G.; Morriss, Fran

doi:10.4037/ccn2001.21.6.25

Cited by 3 publications

(2 citation statements)

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“…56 , 59 , 85 , 118 Reported complications of ECTRs were almost exclusively associated with hemoperfusion and included hypocalcemia, hypotension, and thrombocytopenia. 10 , 12 , 23 , 28 , 51 , 62 , 70 , 74 , 76 , 77 , 79 , 91 , 92 Bleeding or a drop in hemoglobin was documented in three cases. 50 , 70 , 113 …”

Section: Resultsmentioning

confidence: 98%

“… 19 , 20 , 43 , 90 , 99 Although the evidence may be determined as anecdotal, most of the patients who received ECTR (especially hemoperfusion or hemodialysis) appeared to improve rapidly after initiation of the procedure and had an uneventful outcome, including some patients who reportedly ingested doses greater than 500 mg/kg, 29 , 30 , 60 , 62 , 64 , 72 , 85 and who had concentrations over 60 mg/L (254 μmol/L). 8 , 12 , 16 , 51 , 60 , 66 , 70 , 75 , 79 , 82 , 88 , 120 Patients receiving less effective treatments, such as continuous renal replacement therapies (CRRT) and peritoneal dialysis, improved less quickly, over days. 56 , 59 , 85 , 118 Reported complications of ECTRs were almost exclusively associated with hemoperfusion and included hypocalcemia, hypotension, and thrombocytopenia.…”

Section: Resultsmentioning

confidence: 99%

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Extracorporeal treatment for carbamazepine poisoning: Systematic review and recommendations from the EXTRIP workgroup

Ghannoum

Yates

Galvão

et al. 2014

Clinical Toxicology

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Context. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was created to provide evidence and consensus-based recommendations on the use of extracorporeal treatments (ECTRs) in poisoning. Objectives. To perform a systematic review and provide clinical recommendations for ECTR in carbamazepine poisoning. Methods. After a systematic literature search, the subgroup extracted the data and summarized the findings following a pre-determined format. The entire workgroup voted via a two-round modified Delphi method to reach a consensus on voting statements, using a RAND/UCLA Appropriateness Method to quantify disagreement. Anonymous votes were compiled, returned, and discussed in person. A second vote determined the final recommendations. Results. Seventy-four articles met inclusion criteria. Articles included case reports, case series, descriptive cohorts, pharmacokinetic studies, and in-vitro studies; two poor-quality observational studies were identified, yielding a very low quality of evidence for all recommendations. Data on 173 patients, including 6 fatalities, were reviewed. The workgroup concluded that carbamazepine is moderately dialyzable and made the following recommendations: ECTR is suggested in severe carbamazepine poisoning (2D). ECTR is recommended if multiple seizures occur and are refractory to treatment (1D), or if life-threatening dysrhythmias occur (1D). ECTR is suggested if prolonged coma or respiratory depression requiring mechanical ventilation are present (2D) or if significant toxicity persists, particularly when carbamazepine concentrations rise or remain elevated, despite using multiple-dose activated charcoal (MDAC) and supportive measures (2D). ECTR should be continued until clinical improvement is apparent (1D) or the serum carbamazepine concentration is below 10 mg/L (42 the μ in μmol/L looks weird.) (2D). Intermittent hemodialysis is the preferred ECTR (1D), but both intermittent hemoperfusion (1D) or continuous renal replacement therapies (3D) are alternatives if hemodialysis is not available. MDAC therapy should be continued during ECTR (1D). Conclusion. Despite the low quality of the available clinical evidence and the high protein binding capacity of carbamazepine, the workgroup suggested extracorporeal removal in cases of severe carbamazepine poisoning.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Extracorporeal treatment for carbamazepine poisoning: Systematic review and recommendations from the EXTRIP workgroup

Ghannoum

Yates

Galvão

et al. 2014

Clinical Toxicology

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Lack of effect of high-volume continuous veno-venous haemofiltration with dialysis in massive carbamazepine overdose

Shah

Tomlin²,

Sparkes³

2012

BMJ Case Reports

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SummaryA 32-year-old man, with a long history of chronic pain and bipolar disorder, was admitted to our emergency department 2 h after a mixed overdose, predominately consisting of carbamazepine. Following no clinical improvement after four days of ventilation on our intensive care unit (ICU), high-volume continuous veno-venous haemofiltration with dialysis was instituted to enhance the elimination of the carbamazepine. It had no significant effect on the patient's clinical status or serum carbamazepine level. It was discontinued after 48 h. He spontaneously recovered and was discharged uneventfully from ICU after 7 days. BACKGROUND

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Management of acute carbamazepine poisoning: A narrative review

Wang,

Zhang

et al. 2023

World J Psychiatry

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Standard management protocols are lacking and specific antidotes are unavailable for acute carbamazepine (CBZ) poisoning. The objective of this review is to provide currently available information on acute CBZ poisoning, including its management, by describing and summarizing various therapeutic methods for its treatment according to previously published studies. Several treatment methods for CBZ poisoning will be briefly introduced, their advantages and disadvantages will be analyzed and compared, and suggestions for the clinical treatment of CBZ poisoning will be provided. A literature search was performed in various English and Chinese databases. In addition, the reference lists of identified articles were screened for additional relevant studies, including non-indexed reports. Non-peer-reviewed sources were also included. In the present review, 154 articles met the inclusion criteria including case reports, case series, descriptive cohorts, pharmacokinetic studies, and in vitro studies. Data on 67 patients, including 4 fatalities, were reviewed. Based on the summary of cases reported in the included articles, the cure rate of CBZ poisoning after symptomatic treatment was 82% and the efficiency of hemoperfusion was 58.2%. Based on the literature review, CBZ is moderately dialyzable and the recommendation for CBZ poisoning is supportive management and gastric lavage. In severe cases, extracorporeal treatment is recommended, with hemodialysis as the first choice.

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Charcoal hemoperfusion via a continuous venovenous hemofiltration circuit to treat carbamazepine overdose

Cited by 3 publications

References 0 publications

Extracorporeal treatment for carbamazepine poisoning: Systematic review and recommendations from the EXTRIP workgroup

Extracorporeal treatment for carbamazepine poisoning: Systematic review and recommendations from the EXTRIP workgroup

Lack of effect of high-volume continuous veno-venous haemofiltration with dialysis in massive carbamazepine overdose

Management of acute carbamazepine poisoning: A narrative review

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