Efficacy of charcoal hemoperfusion in massive carbamazepine poisoning
Efficacy of charcoal hemoperfusion in massive carbamazepine poisoning
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DOI：
10.1081/clt-120006754
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发表时间：
2002-01-01
期刊：
影响因子：
--
通讯作者：
Dawson, AH
中科院分区：
文献类型：
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作者：
Cameron, RJ;Hungerford, P;Dawson, AH
背景资料：卡马西平中毒可能危及生命。体外药物清除的作用和效果没有明确的定义。病例报告：一名16岁男性服用了34g缓释卡马西平。他的病程因癫痫发作、反复的心脏骤停和肾功能衰竭而变得复杂。出现肠梗阻时妨碍了有效的胃肠道去污染。卡马西平的血药浓度在服药后106小时达93.8 mg/L(397Mumol/L)。有证据表明持续吸收了120小时。他接受了7次木炭血液灌流，总共109.25小时。他随后提出了完全恢复的方法：通过使用17对便利样本测量血液灌流盒传入和传出回路中的卡马西平浓度来评估木炭血液灌流的效果。计算每一次木炭血液灌流的拔出率并绘制其与时间的关系图。结论：萃取率与时间呈线性关系，在0.46~0.02范围内。最大清除量为69毫升/分钟。墨盒饱和度被定义为等于患者固有清除的估计值的清除。在我们的患者中，这相当于在150毫升/分钟的流速下提取比为0.2。根据这个定义，墨盒饱和似乎发生在7小时。在较长的吸收阶段，木炭血液灌流与明显的半衰期显著减少有关，这最容易用中央血管隔室的清除来解释。患者完全康复，没有神经功能障碍的迹象。
Back-ground: Carbamazepinc poisoning can be life threatening. The role and efficacy of extracorporeal drug clearance is not clearly defined. Case Report: A 16-year-old male ingested 34 g of slow-release carbamazepine. His course was complicated by seizures, recurrent cardiac arrests, and renal failure. Intestinal ileus at the time of presentation prevented effective gastrointestinal decontamination. His carbamazepine concentration peaked at 93.8 mg/L (397 mumol/L) 106 hours after ingestion. There was evidence suggesting ongoing absorption for 120 hours. He underwent seven episodes of charcoal hemoperfusion for a total of 109.25 hours. He subsequently made a full recovery Methods: The efficacy of charcoal hemoperfusion was evaluated by measuring the carbamazepine concentrations in the afferent and efferent loops of the hemoperfusion cartridge using 17 paired convenience samples. Extraction ratios were calculated and plotted against time for each individual episode of charcoal hemoperfusion. Conclusion: The extraction ratio was linearly related to time, and ranged 0.46-0.02. The peak clearance was 69 mL/min. Cartridge saturation was defined as a clearance that was equal to an estimate of the patient's intrinsic clearance. In our patient, this was equivalent to an extraction ratio of 0.2 at a flow rate of 150 mL/min. By this definition, cartridge saturation appeared to occur at 7 hours. Charcoal hemoperfusion was associated with a significant reduction in the apparent half-life, which is most easily explained by clearance from the central vascular compartment, during a prolonged absorptive phase. The patient made full recovery without evidence of neurological deficit.