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

Shah, Sachin S; Tomlin, Mark; Sparkes, David

doi:10.1136/bcr-2012-006891

Cited by 7 publications

(3 citation statements)

References 4 publications

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“…Overall, 6 fatalities were described and appeared consequential to carbamazepine exposure instead of the ECTR itself. 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.…”

Section: Resultsmentioning

confidence: 99%

“… 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. 10 , 12 , 23 , 28 , 51 , 62 , 70 , 74 , 76 , 77 , 79 , 91 , 92 Bleeding or a drop in hemoglobin was documented in three cases.…”

Section: Resultsmentioning

confidence: 99%

“…Continuous techniques offer markedly lower clearances and removal rates compared with intermittent techniques 60 , 76 , 85 , 113 , 119 and, as such, are considered to be inferior modalities by EXTRIP and only advocated if hemodialysis is not available (due to technical or staffing reasons in critical care settings). Continuous techniques are usually better tolerated hemodynamically than intermittent techniques, although this is mostly true in cases where net fluid removal is necessary, which would be an unusual requirement in carbamazepine poisoning.…”

Section: Recommendations ( Table 8 )mentioning

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: 99%

Section: Resultsmentioning

confidence: 99%

Section: Recommendations ( Table 8 )mentioning

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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Antiepileptic Drug Removal by Continuous Renal Replacement Therapy: A Review of the Literature

Mahmoud

2016

Clin Drug Investig

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Continuous renal replacement therapy (CRRT) is used for managing acute kidney injury in critically ill patients. Removal of antiepileptic drugs (AEDs) by CRRT could be significant and may complicate patients' intensive care unit stay. The objective of the current review was to summarize the available evidence for AED removal by CRRT. An electronic literature search of PubMed (1946 to May 2016), Medline (1946 to May 2016), and Embase (1974 to May 2016) databases for studies discussing AED removal by CRRT was conducted. A total of 31 case reports discussing 32 patients were found. AEDs reported were levetiracetam (n = 3), valproic acid (n = 9), carbamazepine (n = 10), phenytoin (n = 3), phenobarbital (n = 4), lacosamide (n = 1), gabapentin (n = 1), and topiramate (n = 1). Two-thirds of the reports were about using CRRT in drug overdose and one-third was about AED removal by CRRT during therapy. Based on the current limited evidence and pharmacokinetic characteristics of AEDs, renally eliminated AEDs and/or AEDs with limited protein binding such as levetiracetam are more likely to be removed by CRRT than AEDs that are mainly metabolized and extensively protein bound such as carbamazepine. In conclusion, there is not enough evidence to provide robust dosing recommendations for AEDs in patients undergoing CRRT. Further studies are needed.

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Antiepileptic Drugs

Beal¹

2014

Side Effects of Drugs Annual

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

Cited by 7 publications

References 4 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

Antiepileptic Drug Removal by Continuous Renal Replacement Therapy: A Review of the Literature

Antiepileptic Drugs

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