拉莫三嗪是治疗癫痫发作和双相情感障碍的常用抗惊厥药,但是关于其毒性管理的文献非常有限。已经发表的病例报告表明血液透析在降低血清拉莫三嗪水平方面的潜在作用。以及碳酸氢钠和脂肪乳治疗心律失常。在先前报告的治疗未能稳定患者的病情之后,该病例介绍了我们使用连续静脉-静脉血液透析滤过(CVVHDF)稳定拉莫三嗪水平的成功治疗经验,以及静脉注射利福平作为辅助治疗,以促进拉莫三嗪的代谢。这是一名66岁的男性,在拉莫三嗪过量后被发现无反应。他的第一个拉莫三嗪水平为42.3ug/mL。在医院第1天开始血液透析。尽管进行了血液透析,他的拉莫三嗪水平随着神经和心脏症状的恶化而反弹。在住院第3天,他出现了宽QRS波型快速性心律失常和血流动力学不稳定,拉莫三嗪水平为66.9ug/mL。碳酸氢钠没有效果。给予脂质乳剂以终止心律失常。开始使用CVVHDF和利福平,此后拉莫三嗪水平持续下降。他在第7天成功拔管。拉莫三嗪水平在第9天变得不可检测。患者在第10天出院到精神病院,没有任何神经或行动障碍。CVVHDF在间歇性血液透析中提供的持续药物清除可能在拉莫三嗪水平稳定方面提供了额外的益处,而在这种情况下使用利福平可能会进一步加速拉莫三嗪的代谢。作为第一个报告CVVHDF和利福平使用的病例,我们的经验表明,它们在控制拉莫三嗪的严重毒性方面具有潜在作用.
Lamotrigine is a commonly used anticonvulsant in treating seizures and bipolar disorder, but there is very limited literature on the management of its toxicity. Case reports have been published suggesting the potential role of hemodialysis in lowering serum lamotrigine levels, as well as sodium bicarbonate and lipid emulsion in treating dysrhythmia. After previously reported therapies failed to stabilize the patient\'s condition, the case presents our successful treatment experience using continuous veno-venous hemodiafiltration (CVVHDF) to stabilize lamotrigine levels, as well as intravenous rifampin as adjunctive therapy to facilitate lamotrigine metabolism. This is a 66-year-old male who was found unresponsive after a lamotrigine overdose. His first lamotrigine level was 42.3 ug/mL. Hemodialysis was started on hospital day 1. Despite hemodialysis sessions, his lamotrigine level rebounded with worsening neurological and cardiac symptoms. On hospital day 3, he developed wide-QRS complex tachyarrhythmia and hemodynamic instability with a lamotrigine level of 66.9 ug/mL. Sodium bicarbonate was given without effect. Lipid emulsion was administered which terminated the arrhythmia. CVVHDF and rifampin were started and lamotrigine levels have continuously downtrended since. He was successfully extubated on day 7. Lamotrigine level became undetectable on day 9. The patient was discharged to a psychiatric facility without any neurological or mobility impairment on day 10. The continuous drug clearance provided by CVVHDF over intermittent hemodialysis may have provided additional benefit in lamotrigine level stabilization, while rifampin use in this case may have further accelerated lamotrigine metabolism. As the first case reporting CVVHDF and rifampin use, our experience suggests their potential roles in managing severe lamotrigine toxicity.