Repeat charcoal hemoperfusion treatments in life threatening carbamazepineoverdose

A 16-month-old female experienced a massive carbamazepine ingestion resulti ng in a peak serum carbamazepine concentration of 55 mu g/ml. Clinical mani festations included generalized seizures, coma, shock, and gastrointestinal hypomotility. Gut decontamination was attempted using multiple-dose activa ted charcoal and cathartics. Because of the severity of illness, charcoal h emoperfusion was initiated. The patient underwent three sessions of charcoa l hemoperfusion, each utilizing a fresh cartridge, with one session immedia tely following the other. Serum carbamazepine and carbamazepine-10,11-epoxi de concentrations decreased from 54 mu g/ml to 23 mu g/ml, and 30 mu g/ml t o 17 mu g/ml, respectively, during charcoal hemoperfusion. There were no co mplications. The patient recovered completely and was discharged on the 4th hospital day, Charcoal hemoperfusion should be considered for life-threate ning carbamazepine intoxication, especially when drug-induced gastrointesti nal hypomotility prevents elimination via the gut.