Ghannoum et al listed indications for extracorporeal therapy for a patient with carbamazepine poisoning. The authors are from multiple institutions in Canada, Europe and the United States and are members of the EXTRIP (Extracorporeal Treatments in Poisoning) workgroup.
Patient selection: carbamazepine poisoning
Molecular weight: 236.269 g
Method of extracorporeal therapy:
(1) intermittent hemodialysis
(2) continuous renal replacement therapy (CRRT)
(3) intermittent hemoperfusion
Indications for extracorporeal therapy:
(1) multiple seizures that are refractory to treatment
(2) life-threatening cardiac arrhythmias
(3) prolonged coma
(4) respiratory depression requiring mechanical ventilation
(5) other significant toxicity AND persistently high carbamazepine serum concentrations AND failure of supportive measures and multiple dose activated charcoal treatments
Additional comments:
(1) Carbamazepine is highly protein bound.
(2) Multiple-dose activated charcoal should be continued during extracorporeal therapy.
Goal of therapy:
(1) clinical improvement
(2) serum carbamazepine concentration < 1 mg/dL (< 10 mg/L, < 42.3 µmol/L)
