Charcoal Hemoperfusion in the Treatment of two Cases of Acute Carbamazepine Poisoning

Groot, Gerard de; Heijst, A. N. P. van; Maes, R. A. A.

doi:10.3109/15563658408992566

Cited by 37 publications

(20 citation statements)

References 16 publications

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“…Indeed our patient, who had not previously taken carbamazepine, demonstrated rising levels despite the use of activated charcoal. Additionally, our patient's ratio of carbamazepine-10,11-epoxide/carbamazepine (0.54±0.14, mean±standard deviation) was consistent with that of patients who have never previously taken the drug [7]. Hemoperfusion proved effective in removing not only the parent drug, but its epoxide metabolite as well (Fig.…”

Section: Discussionsupporting

confidence: 59%

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Repeat charcoal hemoperfusion treatments in life threatening carbamazepine overdose

Deshpande

Meert

Valentini

1999

Pediatric Nephrology

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A 16-month-old female experienced a massive carbamazepine ingestion resulting in a peak serum carbamazepine concentration of 55 microg/ml. Clinical manifestations included generalized seizures, coma, shock, and gastrointestinal hypomotility. Gut decontamination was attempted using multiple-dose activated charcoal and cathartics. Because of the severity of illness, charcoal hemoperfusion was initiated. The patient underwent three sessions of charcoal hemoperfusion, each utilizing a fresh cartridge, with one session immediately following the other. Serum carbamazepine and carbamazepine-10,11-epoxide concentrations decreased from 54 microg/ml to 23 microg/ml, and 30 microg/ml to 17 microg/ml, respectively, during charcoal hemoperfusion. There were no complications. The patient recovered completely and was discharged on the 4th hospital day. Charcoal hemoperfusion should be considered for life-threatening carbamazepine intoxication, especially when drug-induced gastrointestinal hypomotility prevents elimination via the gut.

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Section: Discussionsupporting

confidence: 59%

“…Charcoal hemoperfusion has been utilized for the treatment of life-threatening carbamazepine poisoning [6][7][8]. Activated charcoal imbedded in the hemoperfu- sion cartridge competes with plasma proteins for binding of the drug.…”

Section: Discussionmentioning

confidence: 99%

Repeat charcoal hemoperfusion treatments in life threatening carbamazepine overdose

Deshpande

Meert

Valentini

1999

Pediatric Nephrology

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“…Several therapeutic interventions including charcoal hemoperfusion (HP), hemodialysis (HD), hemodiafiltration and plasma exchange have been performed for the treatment of acute CBZ intoxication (5, 6). However, overall multiple-dose activated charcoal HP seems to the most effective and popular treatment option (7, 8). We report a case of severe carbamazepine poisoning who was treated with one session charcoal hemoperfusion.…”

Section: Introductionmentioning

confidence: 99%

Effectivity of One Session Charcoal Hemoperfusion Treatment in Severe Carbamazepine Poisoning

Işık

Soyoral

Karadaş

et al. 2013

Iran Red Crescent Med J

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A carbamazepine intoxication with suicide attempt is a relatively common clinical problem that presenting with coma, respiratory depression, arrhythmia, hemodynamic instability and even death. We report a case of severe carbamazepine poisoning that was successfully treated with one session charcoal hemoperfusion. On admission, the patient was comatose and required ventilator support. Hemoperfusion with coated activated charcoal successfully decreased the serum carbamazepine concentration from 45 µg mL−1 to 21 µg mL−1 within 2 h, with subsequent clinical improvement.

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“…• Clearance values achieved by multiple-dose activated charcoal in the case of carbamazepine, [89][90][91] dapsone, 43 and phenobarbital 96,96 are comparable to those produced by the more invasive techniques of hemodialysis and hemoperfusion.…”

Section: Clinical Studiesmentioning

confidence: 84%

Position Statement and Practice Guidelines on the Use of Multi-Dose Activated Charcoal in the Treatment of Acute Poisoning

Toxicologists¹

1999

Journal of Toxicology: Clinical Toxicology

294

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In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. 1-124 Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the Boards of the two societies.The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based. Although many studies in animals and volunteers have demonstrated that multiple-dose activated charcoal increases drug elimination significantly, this therapyhas not yet been shown in a controlled study in poisoned patients to reduce morbidity and mortality. Further studies are required to establish its role and the optimal dosage regimen of charcoal to be administered. Based on experimental and clinical studies, multiple-dose activated charcoal should be considered only if a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline. With all This Position Statement is endorsed by the Canadian Association of Poison Control Centres. 731 Clinical Toxicology Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15For personal use only. ORDER REPRINTS 732AACT and EAPCCT of these drugs there are data to confirm enhanced elimination, though no controlled studies have demonstrated clinical benefit.Although volunteer studies have demonstrated that multiple-dose activated charcoal increases the elimination of amitriptyline, dextropropoxyphene, digitoxin, digoxin, disopyramide, nadolol, phenylbutazone, phenytoin, piroxicam, and sotalol, there are insufficient clinical data to support or exclude the use of this therapy.The use of multiple-dose charcoal in salicylate poisoning is controversial. One animal study and 2 of 4 volunteer studies did not demonstrate increased salicylate clearance with multiple-dose charcoal therapy. Data in poisoned patients are insufficient presently to recommend the use of multiple-dose charcoal therapy for salicylate poisoning.Multiple-dose activated charcoal did not increase the elimination of astemizole, chlorpropamide, doxepin, imipramine, meprobamate, methotrexate, phenytoin, sodium valproate, tobramycin, and vancomycin in experimental and/or clinical studies.Unless a patient has an intact or protected airway, the administration of multiple-dose activated charcoal is contraindicated. It should not be used in the presence of an intestinal obstruction. The need for concurrent administration of cathartics remains unproven and is not recommended. In particular, cathartics shoul...

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Charcoal Hemoperfusion in the Treatment of two Cases of Acute Carbamazepine Poisoning

Cited by 37 publications

References 16 publications

Repeat charcoal hemoperfusion treatments in life threatening carbamazepine overdose

Repeat charcoal hemoperfusion treatments in life threatening carbamazepine overdose

Effectivity of One Session Charcoal Hemoperfusion Treatment in Severe Carbamazepine Poisoning

Position Statement and Practice Guidelines on the Use of Multi-Dose Activated Charcoal in the Treatment of Acute Poisoning

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