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

Academic Article


  • 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.
  • Authors

    Published In

  • Pediatrics  Journal
  • Digital Object Identifier (doi)

    Author List

  • Askenazi DJ; Goldstein SL; Chang IF; Elenberg E; Feig DI
  • Start Page

  • 406
  • End Page

  • 409
  • Volume

  • 113
  • Issue

  • 2