carbamazepine is an anticonvulsant and mood - stabilizing drug used in the treatment of epilepsy , bipolar disorder , and neuralgic pain syndromes . the therapeutic dose is 15 - 25 mg / kg and required serum levels of carbamazepine are within 4 - 12 g/ ml . the drug 's relatively high molecular weight , elevated volume of distribution , and intense protein - binding render it difficult to extracorporeal removal , but published experience with hemoperfusion or hemodialysis show variable results . in this paper , we report a 19-year - old woman with fatal - dose carbamazepin intoxication who was treated successfully with multiple - dose activated charcoal and hemodialysis . a 19-year - old woman was admitted to the emergency department with a suicide attempt with carbamazepine ( total dose taken was 8000 mg  186 mg / kg ) . glasgow coma scale ( gcs ) was 7 ; blood pressure , 70/40 mm hg ; pulse rate , 112/min rhythmic ; respiratory rate , 22/min ; and body temperature , 36.1c . the recorded laboratory parameters were the following : hemoglobin , 12.8 g/ dl ; leukocyte , 14600/mm ; platelet , 278000/mm ; urea , 22 mg / dl ; creatinine , 0.59 mg/ dl ; sodium , 138 mmol / l ; potassium , 4.5 mmol / l ; calcium , 8.4 mg / dl ; aspartate aminotransferase ( ast ) , 13 u / l ; alanine transaminase ( alt ) , 29 u / l ; arterial blood ph , 7.27 ; pco2 , 40 ; po2,140 ; and hco3 , 18 . a hemodialysis catheter was attached to the right femoral and two consecutive sessions of hemodialysis were performed . pre - hemodialysis serum levels of carbamazepine was 57.7 g / ml ( normal value , 4 - 10 g / ml ; toxic dose , > 15 g / ml ) and serum level of carbamazepine after hemodialysis was 28.9 g / ml . the patient was conscious on the third day with a gcs of 15 ; blood pressure , 110/70 mm hg ; pulse rate , 78/min ; and respiratory rate , 14/min . serum level of carbamazepine was 6.8 g / ml . the patient was transferred to the psychiatric clinic on the fifth day , as she was having persistent suicidal thoughts . ataxia , nystagmus , mydriasis , ophthalmoplegia , sinus tachycardia , atrioventricular block , convulsions , myoclonus , hyperthermia , coma , and respiratory arrest may also be seen . in our case , loss of consciousness , nystagmus , mydriasis , sinus tachycardia , convulsions , coma , hypokalemia , and transient pancytopenia were detected . a 13% mortality was observed in the study of 307 patients with carbamazepine intoxication . a serum concentration of 40 g / ml or more is usually fatal . severe central nervous system depression is typical if oral dose is more than 50 mg / kg.[246 ] in our case , the oral dose was 186 mg / kg and serum level of carbamazepine was 57.7 g / ml . central nervous system depression continued for three days . fluid therapy in the early period , activated charcoal and hemodialysis were administered for drug elimination . it is reported that hemodialysis can be performed in the absence of carbon hemoperfusion as in our case.[710 ] because of high mortality of carbamazepine intoxication , fluid therapy and activated charcoal treatment must be started emergently and hemodialysis must be performed even in the absence of carbon hemoperfusion .
carbamazepine is used in the treatment of epilepsy ; it is also prescribed for treatment of neuralgic pain syndromes and certain affective disorders . carbamazepine intoxication with suicide attempt 
 is a relatively common clinical problem that can result in coma , respiratory depression , arrhythmia , hemodynamic instability , and death . 
 there is no specific antidote . 
 multiple - dose activated charcoal and hemodialysis are the main treatment for carbamazepine intoxication . in this paper 
 , we report the case of a 19-year - old woman with excessive dose carbamazepin intoxication and our successful treatment with multiple - dose activated charcoal and hemodialysis .