Chung Young K, Chang Kyung Y, Park Hoon S, Kim Mi-Hee, Lee Kang-Min, Lim Tae-Seok, Kim Hyung W
Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea; St. Vincent's Hospital, Suwon, Korea.
Hemodial Int. 2014 Apr;18(2):551-5. doi: 10.1111/hdi.12132. Epub 2014 Jan 15.
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.
卡马西平（CBZ）中毒可伴有严重毒性，包括神经和心肺异常。CBZ与蛋白质高度结合，通过传统血液透析无法有效清除。血液灌流是治疗CBZ中毒最有效的体外清除疗法。最近的报告表明，连续性静脉-静脉血液透析滤过（CVVHDF）、白蛋白强化连续性静脉-静脉血液透析、高通量血液透析和血浆置换与血液灌流效果相当。与最近报道的在CBZ中毒中高透析液流量的CVVHDF有效不同，我们观察到低透析液流量的白蛋白强化CVVHDF使血清CBZ水平降低甚微。因此，在严重CBZ中毒时，如果因缺乏设备而无法进行血液灌流或不能实施血液灌流，应考虑采用高透析液流量的白蛋白强化CVVHDF。
