Detoxication Treatment for Carbamazepine and Lithium Overdose

Unei, Hiroko; Ikeda, Hiroaki; Murakami, Teruo; Tanigawa, Koichi; Kihira, Kenji

doi:10.1248/yakushi.128.165

Cited by 11 publications

(6 citation statements)

References 27 publications

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“…There is also no role for charcoal hemoperfusion in the treatment of lithium intoxication as lithium is not adsorbed to charcoal molecules and thus there is no enhancement of elimination. 60,61 Technical aspects of ECTR. Each of blood and dialysate/filtration flows influence solute clearance by ECTR, where the slowest of these flow rates is the rate-limiting step for solute removal.…”

mentioning

confidence: 99%

Lithium Poisoning

Baird-Gunning

Lea‐Henry

Hoegberg

et al. 2016

J Intensive Care Med

126

125

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Lithium is a commonly prescribed treatment for bipolar affective disorder. However, treatment is complicated by lithium's narrow therapeutic index and the influence of kidney function, both of which increase the risk of toxicity. Therefore, careful attention to dosing, monitoring, and titration is required. The cause of lithium poisoning influences treatment and 3 patterns are described: acute, acute-on-chronic, and chronic. Chronic poisoning is the most common etiology, is usually unintentional, and results from lithium intake exceeding elimination. This is most commonly due to impaired kidney function caused by volume depletion from lithium-induced nephrogenic diabetes insipidus or intercurrent illnesses and is also drug-induced. Lithium poisoning can affect multiple organs; however, the primary site of toxicity is the central nervous system and clinical manifestations vary from asymptomatic supratherapeutic drug concentrations to clinical toxicity such as confusion, ataxia, or seizures. Lithium poisoning has a low mortality rate; however, chronic lithium poisoning can require a prolonged hospital length of stay from impaired mobility and cognition and associated nosocomial complications. Persistent neurological deficits, in particular cerebellar, are described and the incidence and risk factors for its development are poorly understood, but it appears to be uncommon in uncomplicated acute poisoning. Lithium is readily dialyzable, and rationale support extracorporeal treatments to reduce the risk or the duration of toxicity in high-risk exposures. There is disagreement in the literature regarding factors that define patients most likely to benefit from treatments that enhance lithium elimination, including specific plasma lithium concentration thresholds. In the case of extracorporeal treatments, there are observational data in its favor, without evidence from randomized controlled trials (none have been performed), which may lead to conservative practices and potentially unnecessary interventions in some circumstances. More data are required to define the risk-benefit of extracorporeal treatments and their use (modality, duration) in the management of lithium poisoning.

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mentioning

confidence: 99%

Lithium Poisoning

Baird-Gunning

Lea‐Henry

Hoegberg

et al. 2016

J Intensive Care Med

126

125

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“…9 Serum CBZ level was decreased 30% to 40% by charcoal hemoperfusion. 10 In our case, charcoal hemoperfusion for 3 hours resulted in a CBZ T 1 ⁄2 of 3.5 hours. Graudins et al 11 reported that initial rapid clearance of CBZ occurs during the first hour of hemoperfusion and T 1 ⁄2 for CBZ during the first hour of hemoperfusion was 0.165 hours, while the T 1 ⁄2 estimated for the patient's endogenous clearance was 6.21 hours.…”

Section: Discussionmentioning

confidence: 50%

“…Adsorba® prevents direct contact between blood and sorbent, and assists in the prevention of charcoal embolization . Serum CBZ level was decreased 30% to 40% by charcoal hemoperfusion . In our case, charcoal hemoperfusion for 3 hours resulted in a CBZ T½ of 3.5 hours.…”

Section: Discussionmentioning

confidence: 52%

Severe carbamazepine intoxication unresponsive to albumin‐enhanced continuous venovenous hemodiafiltration with low dialysate flow

Chung

Chang

Park

et al. 2014

Hemodialysis International

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Carbamazepine (CBZ) intoxication can be associated with severe toxicity, including neurological and cardio-respiratory abnormalities. Highly protein-bound, CBZ is not removed efficiently through conventional hemodialysis. Charcoal hemoperfusion is the most effective extracorporeal elimination therapy for CBZ intoxication. Recent reports have indicated that continuous venovenous hemodiafiltration (CVVHDF), albumin-enhanced continuous venovenous hemodialysis, high-flux hemodialysis and plasma exchange can be as effective as charcoal hemoperfusion. In contrast to recent reports, which demonstrated the effectiveness of CVVHDF with high dialysate flow in CBZ intoxication, 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 if it cannot be performed.

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“…The therapeutic concentration range is 4–12 mg/L (17–51 μ mol/L); significant toxicity usually occurs over 40 mg/L (169 μ mol/L), but also potentially at lower concentrations . According to blood Carbamazepine levels, poisoning can be classified into four stages: potentially catastrophic relapse with levels <11 mg/L, disorientation and ataxia at levels of 11–15 mg/L, combativeness and hallucinations at levels of 15–25 mg/L, and convulsions and coma at levels >25 mg/L . Multiple‐dose activated charcoal (MDAC) increases elimination and improves clinical outcome in patients with Carbamazepine overdose, and is recommended for patients with life‐threatening ingestions .…”

Section: Introductionmentioning

confidence: 99%