Department of Anesthesiology and Intensive Care Medicine, SRH Klinikum Gera, Gera, Germany.
Blood Purif. 2022;51(8):679-682. doi: 10.1159/000519167. Epub 2021 Nov 4.
Severe intoxication with the anti-epileptic drug, lamotrigine can cause cardiovascular collapse, neurotoxicity - expressed as intractable seizures, and even death. As there is currently no known specific antidote, extracorporeal removal therapies such as CytoSorb hemoadsorption might represent a promising therapeutic option. We report on a deeply comatosed 60-year-old woman who was treated in our intensive care unit with severe lamotrigine intoxication. To support removal from the blood, combined treatment with continuous veno-venous hemodialysis and CytoSorb hemoadsorption was started. Pre- and post-adsorber drug level measurements showed the rapid elimination of lamotrigine accompanied by an impressive clinical improvement in the patient. Two days after treatment discontinuation, there were no more clinical signs of intoxication and the patient could be extubated, followed by transfer to the stroke unit in a stable condition the following day. In the absence of a viable antidote, for the efficient short-term removal of lamotrigine, hemoadsorption with the CytoSorb device could represent a feasible treatment option for patients with severe lamotrigine intoxication.
严重的抗癫痫药物拉莫三嗪中毒可导致心血管衰竭、神经毒性——表现为难治性癫痫发作，甚至死亡。由于目前尚无已知的特效解毒剂，细胞吸附剂（如 CytoSorb 血液灌流）等体外清除疗法可能是一种有前途的治疗选择。我们报告了一位深度昏迷的 60 岁女性，她在我们的重症监护病房因严重的拉莫三嗪中毒接受治疗。为了支持血液清除，开始联合使用连续静脉-静脉血液透析和 CytoSorb 血液灌流进行治疗。吸附前后的药物浓度测量显示拉莫三嗪迅速消除，同时患者的临床状况显著改善。治疗停止两天后，患者不再有中毒的临床迹象，可以拔管，随后第二天转入中风病房，情况稳定。在没有有效解毒剂的情况下，为了高效地短期清除拉莫三嗪，CytoSorb 血液灌流装置的血液吸附可能是严重拉莫三嗪中毒患者的一种可行治疗选择。
