Carbamazepine overdose
1
Carbamazep'ne overdose Deep coma and cardiovatcuJar symptOMS A 34-year-old man was admitted to hospital after ingestion of 400 tablets of 'Tegretor (a total dose of BOg of carbamazepine). Respiration was shallow with a systolic BP of 80mm Hg and a heart rate 5O/min. ECG showed an incomplete right bundle branch block. The patient was in a state of coma. T Qxicological screening showed no other drugs besides carbamazepine. !nilia! treatment was supportive and consisted of artificial ventilation, gastric lavage and administration of activated charcoal and dopamine 0.01 mg/kg/min. Due to the severity of symptoms, charcoal haemoperfusion was jnitiated and continued for 3.5 hours on the day of admission and again for 3.5 and 4 hours, respectively, on the 2 following days. The patient received a total of 14500- 18500 IU of heparin during each of the 3 haemoperfusions. On day 4 he was adequately responsive to verbal commands. The calculated clearance rate of carbamazepine was 80-90 ml/min al a blood flow rate of approximately 240 mlj min through the column. Although the post perfusion concentrations of carbamazepine showed a marked decrease, an increase in plasma concentration was noted during the following hours. This was most likely because ot continuous absorption of carbamazepine irom the gut. 80% of carba'llazepine is bound to plasma proteins. Elimination of protein-bound and lipid-soluble drugs have been shown to be enhanced by haemoperfusion as compared with haernodialysis and peritoneal dialysis. In cases of severe carbamazepine overdose, charcoal haemopertusion for more than 4 hours at a time is recommended. The only serious disadvantage is the affinity of platelets tor charcoal and the necessity of concomitant heparinisation. Nilsson. C el al. . Acta Med,ca Scandina.ic8216: 137 (No 1. (984) 0157-7271/84/09221)005/0$01.00/0 ADIS Prep Reactions 22 1984 5
Transcript of Carbamazepine overdose
Carbamazep'ne overdose Deep coma and cardiovatcuJar symptOMS
A 34-year-old man was admitted to hospital after ingestion of 400 tablets of 'Tegretor (a total dose of BOg of carbamazepine). Respiration was shallow with a systolic BP of 80mm Hg and a heart rate 5O/min. ECG showed an incomplete right bundle branch block. The patient was in a state of coma. T Qxicological screening showed no other drugs besides carbamazepine . !nilia! treatment was supportive and consisted of artificial ventilation, gastric lavage and administration of activated charcoal and dopamine 0.01 mg/kg/min. Due to the severity of symptoms, charcoal haemoperfusion was jnitiated and continued for 3.5 hours on the day of admission and again for 3.5 and 4 hours, respectively, on the 2 following days. The patient received a total of 14500-18500 IU of heparin during each of the 3 haemoperfusions . On day 4 he was adequately responsive to verbal commands .
The calculated clearance rate of carbamazepine was 80-90 ml/min al a blood flow rate of approximately 240 mlj min through the column. Although the post perfusion concentrations of carbamazepine showed a marked decrease, an increase in plasma concentration was noted during the following hours. This was most likely because ot continuous absorption of carbamazepine irom the gut. 80% of carba'llazepine is bound to plasma proteins. Elimination of protein-bound and lipid-soluble drugs have been shown to be enhanced by haemoperfusion as compared with haernodialysis and peritoneal dialysis. In cases of severe carbamazepine overdose, charcoal haemopertusion for more than 4 hours at a time is recommended. The only serious disadvantage is the affinity of platelets tor charcoal and the necessity of concomitant heparinisation. Nilsson. C el al. . Acta Med,ca Scandina.ic8216: 137 (No 1. (984)
0157-7271/84/09221)005/0$01.00/0 ~ ADIS Prep Reactions 22 ~p 1984 5
