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Hemoperfusão com carvão activado na intoxicação grave por carbamazepina
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Advisor(s)
Abstract(s)
RESUMO
Caso clínico: Os autores apresentam o caso de uma adolescente
admitida no Serviço de Urgência por alterações neurológicas
de início agudo e progressivas, existindo na residência
um familiar medicado com um antiepiléptico. A avaliação inicial
revelou sonolência, discurso adequado, disartria, nistagmo, dismetria
bilateral e ataxia da marcha.
Foi efectuado doseamento sérico de carbamazepina, que
revelou valores muito elevados, confirmando intoxicação aguda
por este fármaco. Não houve resposta à administração com
carvão activado por via gastrointestinal, havendo mesmo agravamento
do estado de consciência. Por esta razão, iniciou hemoperfusão
com carvão activado, com recuperação completa do
quadro neurológico ao fim de três horas de tratamento.
Conclusão: Os autores sublinham as dificuldades na abordagem
de intoxicações graves provocadas por fármacos com
forte ligação às proteínas, realçando a eficácia da hemoperfusão
com carvão activado.
ABSTRACT Case report: The authors present a case of a teenage girl admitted to the emergency room with a sudden progressive neurologic disorder. A family member was on antiepileptic drug treatment. The initial assessment revealed a drowsy adolescent with appropriate speech, though dysarthric, presenting nystagmus and bilateral dysmetria and gait ataxia. Serum assay was performed and revealed high levels of carbamazepine thus confirming acute poisoning with this drug. Activated charcoal therapy was done with no reponse, even with deterioration of the level of consciousness. Hemoperfusion with activated charcoal was then performed with complete neurological recovery within three hours. Conclusion: The authors underline the difficulties in dealing with severe cases of poisoning caused by drugs with high protein binding and emphasize the effectiveness of hemoperfusion with activated charcoal.
ABSTRACT Case report: The authors present a case of a teenage girl admitted to the emergency room with a sudden progressive neurologic disorder. A family member was on antiepileptic drug treatment. The initial assessment revealed a drowsy adolescent with appropriate speech, though dysarthric, presenting nystagmus and bilateral dysmetria and gait ataxia. Serum assay was performed and revealed high levels of carbamazepine thus confirming acute poisoning with this drug. Activated charcoal therapy was done with no reponse, even with deterioration of the level of consciousness. Hemoperfusion with activated charcoal was then performed with complete neurological recovery within three hours. Conclusion: The authors underline the difficulties in dealing with severe cases of poisoning caused by drugs with high protein binding and emphasize the effectiveness of hemoperfusion with activated charcoal.
Description
Keywords
Carbamazepina intoxicação sobredosagem antiepilépticos hemoperfusão carvão activado alteração do estado de consciência Carbamazepine poisoning overdose antiepileptic drugs hemoperfusion activated charcoal disturbed level of consciousness
Citation
Nascer e Crescer 2011; 20(1): 23-25