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PEDIATRICS Vol. 113 No. 2 February 2004, pp. 406-409

EXPERIENCE AND REASON

Management of a Severe Carbamazepine Overdose Using Albumin-Enhanced Continuous Venovenous Hemodialysis

David J. Askenazi, MD*, Stuart L. Goldstein, MD*, I-Fen Chang, PharmD{ddagger}, Ewa Elenberg, MD* and Daniel I. Feig, MD, PhD*

* Renal Section
{ddagger} Pharmacy, Department of Pediatrics, Baylor College of Medicine, Houston, Texas

Carbamazepine intoxication is common in the pediatric population. Highly protein-bound, carbamazepine is not removed efficiently through conventional hemodialysis. We describe the use of albumin-enhanced continuous venovenous hemodialysis (CVVHD) in a 10-year-old girl who developed coma and respiratory depression due to an intentional carbamazepine overdose (peak drug level of 44.8 µg/ml; therapeutic range: 8–12 µg/ml). Without intervention, the half-life of drug elimination is 25 to 60 hours in patients who are naive to carbamazepine and 12 to 20 hours in children on chronic carbamazepine therapy. In contrast, with albumin-enhanced CVVHD, we observed a half-life of 7 to 8 hours. The patient recovered rapidly and was discharged from hospital <4 days from the time of ingestion with no complications or neurologic impairment. Because the cost-benefit analysis was also favorable relative to other therapeutic options, albumin-enhanced CVVHD may be the optimal treatment of toxic-level ingestion of carbamazepine.

Key Words: dialysis • CVVHD • CRRT • carbamazepine • overdose

Abbreviations: ICU, intensive care unit • CVVHD, continuous venovenous hemodialysis

Received for publication Jan 30, 2003; Accepted Apr 28, 2003.


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