Ram Prabahar Murugesan, Raja Karthik Kalidindi, Singh Mohini, Singh Raja Beem, Singh Sudhagar, Dhamodharan Jayachandran
Department of Nephrology, Sri Ramachandra Medical College, Chennai, India.
Hemodial Int. 2011 Jul;15(3):407-11. doi: 10.1111/j.1542-4758.2011.00559.x. Epub 2011 May 31.
A 48-year-old man was brought to the emergency room after ingesting an unknown amount of carbamazepine. He was unconscious and not responding to the noxious stimuli. He was intubated and was placed on mechanical ventilation because of respiratory insufficiency. Primary detoxification was performed with a gastric lavage and charcoal instillation. His serum carbamazepine level was 25.6 mcg/mL at the time of admission. His computed tomography of the brain was normal. He was managed conservatively but there was no improvement in his neurological status in the next 24 hours. Serum carbamazepine level was repeated and reported to be 28.3 mcg/mL. As there was no improvement in his sensorium and the serum carbamazepine levels remained persistently high, extracorporeal removal of carbamazepine was attempted. As the facility to carry out hemoperfusion was not available immediately, the decision to initiate hemodialysis was taken. After 3 sessions of hemodialysis, his sensorium improved markedly and the carbamazepine level at this time was within the therapeutic range. He was discharged after psychiatry consultation and counseling. We review the literature regarding extra corporeal techniques for the removal of carbamazepine and discuss them in this article.
一名48岁男子在摄入未知量的卡马西平后被送往急诊室。他昏迷不醒，对有害刺激无反应。由于呼吸功能不全，他被插管并接受机械通气。通过洗胃和注入活性炭进行初步解毒。入院时他的血清卡马西平水平为25.6 mcg/mL。他的脑部计算机断层扫描正常。他接受了保守治疗，但在接下来的24小时内神经状态没有改善。再次检测血清卡马西平水平，结果为28.3 mcg/mL。由于他的意识没有改善且血清卡马西平水平持续居高不下，尝试进行卡马西平的体外清除。由于无法立即进行血液灌流，决定开始进行血液透析。经过3次血液透析后，他的意识明显改善，此时卡马西平水平在治疗范围内。在接受精神科会诊和咨询后他出院了。我们回顾了有关卡马西平体外清除技术的文献并在本文中进行讨论。
