2024 Volume 14 Issue 2 Pages 93-96
In this report, we describe a case of possible accidental overdose of carbamazepine (CBZ) treated successfully with hemodiafiltration (HDF). An unconscious 70-year-old female was brought to our hospital and intubated with a bronchial tube. She was managed under a respirator because of epilepsy, bradycardia and circulatory failure. She was diagnosed with CBZ toxicity on day 1, and continuous HDF (CHDF) was performed for three days, followed by HDF. Once HDF was initiated, CBZ serum concentrations returned to normal range, which coincided with regained consciousness. She was extubated and weaned from the respirator on day 14, and she was discharged on day 25．Direct plasma absorption (DHP) has been reported as a standard treatment for CBZ toxicity. However, recent reports indicated that hemodialysis may be as effective as DHP for CBZ toxicity. In fact, HDF was shown to be beneficial for our case. Since the efficacy of CHDF is inferior to HDF, HDF should be the preferred treatment. However, for a patient with circulatory insufficiency like our case, HDF would be difficult to initiate. Thus, we have shown that for a patient with unstable hemodynamics, it may be optimal to introduce CHDF at first and subsequently shift to HDF.
