Carbamazepine poisoning: treatment with plasma exchange

Lethal cases due to carbamazepine overdose have been reported. There are co ntradicting reports about the efficiency of hemodialysis, hemoperfusion and plasmapheresis for the treatment of carbamazepine poisoning. We present a case of carbamazepine intoxication successfully managed with plasma exchang e. The patient was a 15 -year- old girl. On admission there was no evidence of trauma, Glasgow Coma Scale scored 6. Further questioning of the parents revealed the patient had taken at least 23 tablets of Tegretol((R)) (4.6 g ) 6 h before the admission. The carbamazepine level was 190 mu mol/l. Oroga stric lavage was followed by activated charcoal. Within 20 h after admissio n there was no improvement in her neurological status. It was thus decided to perform plasmapheresis. At the end of the procedure she started to respo nd to verbal stimuli. Carbamazepine level immediately after the procedure w as 101 mu mol/l, and at the 36th, 60th and 84th hours were 72, 33 and 20 mu mol/l, respectively. The patient was discharged on the fourth day. We have not observed any rebound in our patient. Thus we suggest that simple plasm a exchange by plasma replacement is a cheaper and effective method for the treatment of intoxication with carbamazepine or similar drugs.