2019 Volume 10 Issue 1 Pages 40-42
【Case Report】A 31-year-old woman was referred to the emergency department of our hospital because of the ingestion of 4,000mg of carbamazepine as a suicide attempt. Upon physical examination, the patient was in a coma and was not responsive to any stimuli. Her serum carbamazepine level was 36.4μg/mL. After pre-dilution online HDF was performed for 3.5 hours at a blood flow rate of 250mL/min, a total dialysate flow rate of 700mL/min, and a substitution fluid flow rate of 250mL/min, the patient showed a marked improvement of nausea･consciousness disturbance and her carbamazepine level had decreased to 19.1μg/mL. The patient was discharged from the hospital because her serum carbamazepine level was normalized 2 days after pre-dilution online HDF was performed. Several modalities have been used to treat severe poisoning arising from carbamazepine overdose. Hemoperfusion has traditionally been considered the gold standard for the elimination of highly bound substances, such as carbamazepine. According to the Extracorporeal Treatments in Poisoning Workgroup recommendations, carbamazepine is dialyzable, and intermittent HD is the preferred modality suggested in cases with coma. Carbamazepine has a high plasma protein binding (70–80%); hence, HD is thought to have a limited effect on the removal of carbamazepine from the plasma. In the present case, we selected pre-dilution online HDF, which is more efficient than HD. We hypothesized that pre-dilution online HDF would be effective for the removal of protein-bound carbamazepine and removal of free serum carbamazepine.
