Reactions 1360 - 16 Jul 2011

O SCarbamazepine overdose

Multiorgan dysfunction, treated with resinhaemoperfusion: case report

A 48-year-old man developed multiorgan dysfunctionfollowing an overdose of carbamazepine, which wassuccessfully treated with resin haemoperfusion.

Around 30 hours after the onset of unconsciousness, theman was referred to an emergency department. Onexamination, he was in a deep coma with diffuse ralesbilaterally, diminished bowel sounds, positive Babinskisigns bilaterally and grade 0 muscle power in his upper andlower limbs. Laboratory tests results indicated multiorgandysfunction including respiratory depression and cardiacinsufficiency. Questioning revealed the man had a historyof cerebral cysticercosis for which he receivedcarbamazepine 2 months earlier [dosage and route notstated]. He was intubated for assisted ventilation andtransferred to an ICU where he received supportivemeasures, diuretics and activated charcoal gastric lavage.The following day, analysis of a sample takenpostadmission revealed a serum carbamazepineconcentration > 20 mg/L (reference range 4.0–12.0 mg/L)and acute severe carbamazepine poisoning was diagnosed.

Resin haemoperfusion was immediately started(approximately 54 hours postingestion), leading to gradualimprovement of laboratory parameters. The man’s serumcarbamazepine concentration decreased to 15.32 mg/Lafter the first course of haemoperfusion and was withintherapeutic limits after a second course. His level ofconsciousness had improved by hospital day 5 and heawoke on day 6 after receiving four courses. He wasdischarged without major sequelae 10 days postadmission;he did have some lower limb sensory impairment.Li TG, et al. Acute carbamazepine poisoning treated with resin hemoperfusionsuccessfully. American Journal of Emergency Medicine 29: 518-522, No. 5, Jun2011. Available from: URL: http://dx.doi.org/10.1016/j.ajem.2009.12.006 -China 803057358

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Reactions 16 Jul 2011 No. 13600114-9954/10/1360-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved