Effectivity of One Session Charcoal Hemoperfusion Treatment in Severe Carbamazepine Poisoning

Abstract

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.

Overdose with antiepileptic drugs: the efficacy of extracorporeal removal techniques

“…It has the advantage of removing toxins that are highly bound to serum proteins as activated charcoal competes with plasma proteins for drug binding 10 16 18 24. In our case, CHP led to a reduction of 53% in CBZ and 68% in VPA concentration, similar to other described cases 7 13 17. This technique enhances the body drug clearance, reducing possible side effects and leading to a faster recovery of consciousness, with short intubation and hospitalisation periods.…”

“…Risk of toxicity rises as CBZ and VPA plasma concentration increases; serious complications can occur with concentrations of CBZ over 40 μg/mL and VPA over 180 μg/mL 12 13 15. In this case, toxic levels of both drugs were reached just before CHP initiation.…”

“…CBZ has a molecular weight of 236 Da and a slow absorption rate that, in cases of overdose, becomes erratic and can be largely extended with peak levels occurring up to 100 h after ingestion 5 12–14 21. Additionally, elevated serum concentrations of CBZ may persist due to a continued absorption from the gut because of gastrointestinal hypomotility (anticholinergic side effect of this drug) 6 10 13 14 19. CBZ is 75 to 90% protein bound but, in concentrations higher than therapeutic, the percentage of free molecules circulating in blood is greater 5 6 19.…”

“…CHP is preferred since it is the most effective way of removing CBZ and VPA, although it is not easily accessible 5–7 10 11 13 14 17 19–23…”

“…Toxicity increases as plasma concentration rises above therapeutic range; if it goes higher than 40 μg/mL, serious complications such as respiratory depression, apnoea, coma and ventricular arrhythmias can occur 12 13. Children and adolescents may be at greater risk at lower serum levels than adults 6 14.…”