Baylis Simon, Costa-Pinto Rahul, Hodgson Sarah, Bellomo Rinaldo, Baldwin Ian
Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia,
Blood Purif. 2022;51(9):721-725. doi: 10.1159/000520520. Epub 2021 Dec 8.
Carbamazepine (CBZ) is a widely used anticonvulsant with a low molecular weight that allows for extracorporeal removal of free drug by both dialytic and hemoperfusion techniques, particularly in a massive overdose where serum protein binding is saturated. This report presents a case of CBZ intoxication where we were able to compare the mass removal of CBZ using hemoperfusion, with the mass removal of CBZ achieved with continuous renal replacement therapy (CRRT) during combined treatment.
The Jafron HA230 resin hemoperfusion cartridge was applied in series with the continuous veno-venous hemofiltration (CVVH) circuit. Baseline and ongoing serum drug levels along with further samples from pre- and post-hemoperfusion cartridges and from CVVH effluent were collected.
Combined CVVH and resin hemoperfusion therapy in series was associated with a 50% reduction in the CBZ level from 16 mg/L to 8 mg/L over 3 h, far more rapid than that observed with CVVH alone or in the absence of extracorporeal drug clearance in the preceding hours. The combination therapy removed close to 35 mg/h of CBZ.
The combination of CRRT and hemoperfusion can be easily deployed, appears safe, and is able to combine the CBZ mass removal achieved with each technique, thus to maximize CBZ extraction.
卡马西平（CBZ）是一种广泛使用的抗惊厥药，分子量低，可通过透析和血液灌流技术体外清除游离药物，特别是在大量用药导致血清蛋白结合饱和的情况下。本报告介绍了一例卡马西平中毒病例，在此病例中我们能够比较血液灌流对卡马西平的清除量与联合治疗期间持续肾脏替代疗法（CRRT）对卡马西平的清除量。
将Jafron HA230树脂血液灌流柱与持续静静脉血液滤过（CVVH）回路串联应用。收集基线和持续的血清药物水平以及血液灌流柱前后和CVVH流出液的进一步样本。
CVVH与树脂血液灌流串联联合治疗在3小时内使卡马西平水平从16毫克/升降至8毫克/升，降低了50%，远比单独使用CVVH或在前几小时没有体外药物清除时观察到的速度要快。联合治疗每小时清除近35毫克卡马西平。
CRRT与血液灌流的联合应用易于实施，似乎安全，并且能够结合每种技术实现的卡马西平清除量，从而最大限度地提高卡马西平的清除率。
