Efficacy of Charcoal Hemoperfusion in Massive Carbamazepine Poisoning

Abstract

The extraction ratio was linearly related to time, and ranged 0.46-0.02. The peak clearance was 69 mL/min. Cartridge saturation was defined as a clearance that was equal to an estimate of the patient's intrinsic clearance. In our patient, this was equivalent to an extraction ratio of 0.2 at a flow rate of 150 mL/min. By this definition, cartridge saturation appeared to occur at 7 hours. Charcoal hemoperfusion was associated with a significant reduction in the apparent half-life, which is most easily explained by clearance from the central vascular compartment, during a prolonged absorptive phase. The patient made full recovery without evidence of neurological deficit.

Hemoperfusion in the Treatment of Acute Clozapine Intoxication in China

“…7 Hemoperfusion is an extracorporeal drug removal intervention in which the blood passes over an adsorbent structure to directly remove its toxic substances. 16 It is a very effective treatment if the drug is highly protein bound, has a higher molecular weight, is lipid soluble, and has a small volume distribution. [17][18][19] The protein binding rate of clozapine is more than 90%, its molecular mass is 326.83 d, and it is lipid-soluble compound.…”

Successful treatment of carbamazepine poisoning with hemodialysis: A case report and review of the literature

“…A few reports in the 1980s showed the efficacy of hemoperfusion in reducing the plasma levels of carbamazepine by 25% to 50% in intoxicated patients 9 . Since then, hemoperfusion has been considered to be the treatment of choice in a severe carbamazepine overdose 5,11 . But many reports are available in the literature regarding the efficacy of other modes of extra corporeal removal like plasmapheresis, 19–21 hemodialysis, and continuous venovenous hemodiafiltration (CVVHDF).…”

“…In the management of an acute carbamazepine overdose, different therapeutic interventions such as charcoal hemoperfusion, hemodialysis, and plasma exchange have been reported to be effective with supportive measures. 2,5,6,[11][12][13][14][15][16][17][18][19][20][21] Among the extracorporeal techniques, hemoperfusion is considered as the best modality to remove carbamazepine as it is a highly protein bound drug. 5,11 However, the facility to carry out hemoperfusion is not available immediately in our center.…”

“…Several forms of extra corporeal removal of carbamazepine overdose have been attempted earlier 6 . Although hemoperfusion is considered to be the procedure of choice, 5,11 hemodialysis, 2,12,13 high‐efficiency hemodialysis, 14 high‐flux dialysis, 15,16 continuous renal replacement therapy techniques, 6,17,18 and plasma exchange 19–21 have also been reported to enhance the elimination of carbamazepine. But these invasive, resource‐intensive interventions are not justified unless risk assessment indicates a potential for prolonged coma, seizures, or cardiovascular instability.…”

Activation-Dependent Adsorption of Cytokines and Toxins Related to Liver Failure to Carbon Beads

“…Plasma without adsorbents served as a control. At defined time points (15,30, 60 min), samples were drawn from each tube, centrifuged immediately at 4600g to remove the adsorbent, and the supernatant was aliquoted and stored at À20°C until further analysis. Bilirubin, cholic acid, and serum albumin were quantified using a Roche/Hitachi 902 automatic analyzer (Roche Diagnostics GmbH, Mannheim, Germany); tryptophan and phenol concentrations were measured by reverse-phase HPLC (Waters GmbH, Eschborn, Germany), as previously described in detail.…”