Peces R, Azorín S, Peces C, Selgas R
Servicio de Nefrología, Hospital Universitario La Paz, Madrid, Spain.
Nefrologia. 2010;30(1):127-30. doi: 10.3265/Nefrologia.pre2010.Jan.10217.
Carbamazepine is used in the treatment of epilepsy, and also prescribed in neuralgic pain syndromes, and certain affective disorders. Carbamazepine intoxication with suicide attempt is a relatively common clinical problem that can result in coma, respiratory depression, arrhythmia, hemodynamic instability and death. The drug's relatively high molecular weight, elevated volume of distribution and intense protein-binding render it difficult to extracorporeal removal, but published experience with hemoperfusion or hemodialysis present variable results. We describe a case report involving carbamazepine intoxication who was successfully treated with charcoal hemoperfusion. With this treatment the half-life of carbamazepine was reduced with rapid lowering of carbamazepine levels and clinical improvement. Based on our experience in this patient and a review of previously reported cases, extended charcoal hemoperfusion should be considered for serious carbamazepine intoxication because free as well as bound drug fractions are eliminated via this technique.
卡马西平用于治疗癫痫，也被用于治疗神经痛综合征和某些情感障碍。卡马西平中毒并伴有自杀企图是一个相对常见的临床问题，可导致昏迷、呼吸抑制、心律失常、血流动力学不稳定和死亡。该药物相对较高的分子量、分布容积增加以及强烈的蛋白结合使其难以通过体外清除，但关于血液灌流或血液透析的已发表经验结果不一。我们描述了一例卡马西平中毒患者，通过活性炭血液灌流成功治愈。通过这种治疗，卡马西平的半衰期缩短，卡马西平水平迅速降低，临床症状改善。基于我们对该患者的经验以及对先前报道病例的回顾，对于严重的卡马西平中毒，应考虑采用延长的活性炭血液灌流，因为通过该技术可清除游离药物以及结合药物部分。
