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      Combined Hemoperfusion and Continuous Veno-Venous Hemofiltration for Carbamazepine Intoxication


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          Introduction: Carbamazepine (CBZ) is a widely used anticonvulsant with a low molecular weight that allows for extracorporeal removal of free drug by both dialytic and hemoperfusion techniques, particularly in a massive overdose where serum protein binding is saturated. This report presents a case of CBZ intoxication where we were able to compare the mass removal of CBZ using hemoperfusion, with the mass removal of CBZ achieved with continuous renal replacement therapy (CRRT) during combined treatment. Methods: The Jafron HA230 resin hemoperfusion cartridge was applied in series with the continuous veno-venous hemofiltration (CVVH) circuit. Baseline and ongoing serum drug levels along with further samples from pre- and post-hemoperfusion cartridges and from CVVH effluent were collected. Results: Combined CVVH and resin hemoperfusion therapy in series was associated with a 50% reduction in the CBZ level from 16 mg/L to 8 mg/L over 3 h, far more rapid than that observed with CVVH alone or in the absence of extracorporeal drug clearance in the preceding hours. The combination therapy removed close to 35 mg/h of CBZ. Conclusion: The combination of CRRT and hemoperfusion can be easily deployed, appears safe, and is able to combine the CBZ mass removal achieved with each technique, thus to maximize CBZ extraction.

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          Most cited references13

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          Is Open Access

          A New Series of Sorbent Devices for Multiple Clinical Purposes: Current Evidence and Future Directions

          Adsorption is an extracorporeal technique utilized for blood purification. It complements convection and diffusion (the main modalities of solute removal). It involves the passage of blood (or plasma) through an adsorption cartridge, where solutes are removed by direct binding to the sorbent material. Over the years, new adsorption cartridges, with improved characteristics have been developed. Furthermore, the therapeutic applications of adsorption have expanded. These now involve the treatment of inflammatory conditions, chronic uremic symptoms, and autoimmune disease, in addition to intoxication, which was once considered the classical indication for adsorption therapy. HA130, HA230, and HA330 (Jafron, Zhuhai City, China) are among the widely used adsorption cartridges in China. There has been sufficient body of evidence to support their effectiveness and safety. In this review, we aim to highlight their main clinical applications.
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            Extracorporeal Sorbent Technologies: Basic Concepts and Clinical Application.

            Limitations imposed by the characteristics of some solutes and the structure of dialysis membranes have spurred new interest in the use of mechanisms beyond diffusion and convection for extracorporeal solute removal. Sorbents have been utilized for more than 50 years in extracorporeal blood treatments for specific purposes, and better understanding of their basic aspects may further expand the potential for their clinical application. In this chapter, the basic principles applying to sorbents are discussed, including composition and structure, along with the fundamental mechanisms of solute removal. The critical importance of sorbent biocompatibility is also highlighted. With these basic principles in mind, the clinical application of sorbents is discussed, with an emphasis on the use of hemoperfusion and coupled plasma filtration-adsorption for sepsis-related disorders. Finally, new sorbent-based clinical approaches for acute conditions and end-stage renal disease are presented, emphasizing that sorbent technologies may assume a larger role for a variety of clinical disorders in the future.
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              Successful treatment of carbamazepine poisoning with hemodialysis: a case report and review of the literature


                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                September 2022
                08 December 2021
                : 51
                : 9
                : 721-725
                [_a] aDepartment of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
                [_b] bDepartment of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
                [_c] cVictorian Poisons Information Centre, Austin Hospital, Melbourne, Victoria, Australia
                [_d] dThe Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
                Author notes
                *Ian Baldwin, Ian.BALDWIN@austin.org.au
                Author information
                520520 Blood Purif 2022;51:721–725
                © 2021 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.

                : 10 August 2021
                : 23 October 2021
                Page count
                Figures: 2, Tables: 1, Pages: 5
                There are no funding sources to declare.
                Research Article

                Cardiovascular Medicine,Nephrology
                Hemoperfusion,Carbamazepine,Hemofiltration,Intoxication,Case report
                Cardiovascular Medicine, Nephrology
                Hemoperfusion, Carbamazepine, Hemofiltration, Intoxication, Case report


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