International Medical Case Reports Journal (Apr 2022)
Severe Carbamazepine Toxicity Treated with Continuous Venovenous Hemofiltration at Palestine Medical Complex: Two Case Reports
Abstract
Mowaffaq A Nasif,1 Hiba H Falana,2 Heba KH Hamed,1 Qusai GH Yousef,3 Mohammad A Jaradat1 1Intensive Care Unit, Palestine Medical Complex, Ramallah, Palestine; 2Department of Pharmacy, Birzeit University, Ramallah, Palestine; 3Internal Medicine Department, Al-Quds University, Jerusalem, PalestineCorrespondence: Hiba H Falana, Department of Pharmacy, Birzeit University, PO Box 14, Birzeit, Ramallah, Palestine, Tel +970-595193486, Fax +970-2-2982017, Email [email protected]: Carbamazepine intoxication is not uncommon and accounts for many cases of poisoning among anticonvulsive medications users. Since there is no specific antidote for carbamazepine overdose, management is limited to gastric decontamination and supportive therapy. With its high protein binding, the role of extracorporeal elimination in carbamazepine intoxication is still questionable. Here two cases of severe carbamazepine intoxication are presented; the cases were brought to the emergency department after the ingestion of 12,000 mg of controlled release carbamazepine for the first case, and unknown amounts of the same drug for the second case. Both cases were presented with altered mental status, convulsion, and high serum carbamazepine levels of more than 20 mcg/mL. They were intubated and treated with continuous venovenous hemofiltration, after which carbamazepine levels declined significantly along with subsequent clinical improvement and complete neurological recovery. Both cases were discharged home for further psychiatric care.Keywords: carbamazepine, poisoning, continuous renal replacement therapy
