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Carbamazepine poisoning: treatment with plasma exchange

Pediatric Nephrology and Rheumatology Unit, Department of Pediatrics, Hacettepe University, Faculty of Medicine, 06100 Ankara Turkey

E Baskin

Y Usta

S Ozen

Department of Pediatrics, Pediatric Nephrology and Rheumatology Unit, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey

Lethal cases due to carbamazepine overdose have been reported. There are contradicting reports about the efficiency of hemodialysis, hemoperfusion and plasmapheresis for the treatment of carbamazepine poisoning. We present a case of carbamazepine intoxication successfully managed with plasma exchange. The patient was a 15-year-old girl. On admission there was no evidence of trauma, Glascow Coma Scale scored 6. Further questioning of the parents revealed the patient had taken at least 23 tablets of Tegretol® (4.6 g) 6 h before the admission. The carbamazepine level was 190µmol/l. Orogastric lavagewasfollowedby activated charcoal. Within 20 h after admission there was no improvement in her neurological status. It was thus decided to perform plasmapheresis. At the end of the procedure she started to respond to verbal stimuli. Carbamazepine level immediately after the procedure was 101 µmol/l, and at the 36th, 60th and 84th hours were 72, 33 and 20 µmol/l, respectively. The patient was discharged on the fourth day. We have not observed any rebound in our patient. Thus we suggest that simple plasma exchange by plasma replacement is a cheaper and effective method for the treatment of intoxication with carbamazepine orsimilar drugs.

Key Words: carbamazepine • poisoning • plasma exchange

Human & Experimental Toxicology, Vol. 20, No. 4, 175-177 (2001)
DOI: 10.1191/096032701678766831


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