I put together these medical challenges. The cases are hypothetical and do not necessarily represent actual or typical presentations of medical diseases. Disclaimer is at the bottom of this page.
Thursday, September 22, 2011
Doesn't Bind GABA Receptor
A 25 year old woman with bipolar disease attempts suicide by overdosing on gabapentin. She's taken about one hundred 400mg tablets.
interestingly...this is one of the toxins you don't have to dialyze! - Doesn’t Bind GABA Receptor
The antidote is the tincture of time. Gabapentin is actively transported by a saturable receptor in the proximal small bowel, and thus, increasing doses overwhelm the transport system and are not absorbed. The patient may have an osmotic diarrhea, but will not die from a gabapentin overdose. With regard to the title, gabapentin was designed to be structurally related to GABA but it instead binds a voltage gated calcium channel.
I found this and thought it would be interesting in regards to the above case. I also think giving calcium gluconate might help with depression of the nervous system.
CASE REPORT Flumazenil and Dialysis for Gabapentin-Induced Coma Toni C Butler, MD Resident, Department of Surgery, Bassett Healthcare, Cooperstown, NY Raquel M Rosen, MD Attending Physician, Division of Nephrology, Department of Adult and Pediatric Medicine, Bassett Healthcare Allison L Wallace , PharmD Pharmacy Resident, Bassett Healthcare Guy W Amsden, PharmD + Author Affiliations Clinical Pharmacy Specialist and Research Scientist, Clinical Pharmacology Research Center, Department of Adult and Pediatric Medicine, Bassett Healthcare Reprints: Guy W Amsden PharmD, Clinical Pharmacology Research Center, Bassett Healthcare, One Atwell Rd., Cooperstown, NY 13326-1394, FAX 607/547 -6914, E-mail guy.amsden @bassett.org - Navigate This Article Top Abstract Case Report Discussion Summary References Next Section Abstract OBJECTIVE: To describe a case of gabapentin-induced coma that was reversed with flumazenil and hemodialysis. CASE SUMMARY: We describe an 83- year-old dialysis-dependent white man who became comatose after a single dose of gabapentin for phantom limb pain. The patient was successfully revived from the coma with administration of flumazenil, which was then followed by hemodialysis. Serum concentration data before and 4 hours after dialysis document the effectiveness of hemodialysis for gabapentin toxicity. DISCUSSION: An objective causality assessment revealed that this adverse event was probably related to the gabapentin that the patient received. To our knowledge, this is the first documented case of not only gabapentin-induced coma, but also the effectiveness of flumazenil for treatment of this type of coma. Although therapeutic hemodialysis has been previously described, our case report is strengthened by the serum concentration monitoring accompanying it. CONCLUSIONS: This report underscores the importance of initiating gabapentin therapy at low doses in dialysis- dependent patients and introduces a novel treatment for those who experience toxicity. flumazenil gabapentin hemodialysis Due to its lack of significant toxicity, need for monitoring, and drug interactions, as well as its rapid onset of action, gabapentin is now commonly being used as first-line therapy for phantom limb pain and other neuropathic pain syndromes. 1 Although transient somnolence is relatively common, especially in the elderly, more serious central nervous system adverse effects are rare. We describe an elderly, hemodialysis- dependent man who became comatose after a single dose of gabapentin and the unique treatment regimen which successfully returned him to his baseline mental status. Previous Section Next Section
Dialysis! : )
ReplyDeleteinterestingly...this is one of the toxins you don't have to dialyze!
ReplyDelete-
Doesn’t Bind GABA Receptor
The antidote is the tincture of time. Gabapentin is actively transported by a saturable receptor in the proximal small bowel, and thus, increasing doses overwhelm the transport system and are not absorbed. The patient may have an osmotic diarrhea, but will not die from a gabapentin overdose. With regard to the title, gabapentin was designed to be structurally related to GABA but it instead binds a voltage gated calcium channel.
Source: UpToDate.
I found this and thought it would be interesting in regards to the above case. I also think giving calcium gluconate might help with depression of the nervous system.
ReplyDeleteCASE REPORT
Flumazenil and Dialysis for
Gabapentin-Induced Coma
Toni C Butler, MD
Resident, Department of Surgery,
Bassett Healthcare, Cooperstown,
NY
Raquel M Rosen, MD
Attending Physician, Division of
Nephrology, Department of Adult
and Pediatric Medicine, Bassett
Healthcare
Allison L Wallace , PharmD
Pharmacy Resident, Bassett
Healthcare
Guy W Amsden, PharmD
+
Author Affiliations
Clinical Pharmacy Specialist and
Research Scientist, Clinical
Pharmacology Research Center,
Department of Adult and Pediatric
Medicine, Bassett Healthcare
Reprints:
Guy W Amsden PharmD, Clinical
Pharmacology Research Center,
Bassett Healthcare, One Atwell Rd.,
Cooperstown, NY 13326-1394, FAX
607/547 -6914, E-mail
guy.amsden @bassett.org
-
Navigate This Article
Top
Abstract
Case Report
Discussion
Summary
References
Next Section
Abstract
OBJECTIVE: To describe a case of
gabapentin-induced coma that was
reversed with flumazenil and
hemodialysis.
CASE SUMMARY: We describe an 83-
year-old dialysis-dependent white
man who became comatose after a
single dose of gabapentin for
phantom limb pain. The patient was
successfully revived from the coma
with administration of flumazenil,
which was then followed by
hemodialysis. Serum concentration
data before and 4 hours after dialysis
document the effectiveness of
hemodialysis for gabapentin toxicity.
DISCUSSION: An objective causality
assessment revealed that this adverse
event was probably related to the
gabapentin that the patient received.
To our knowledge, this is the first
documented case of not only
gabapentin-induced coma, but also
the effectiveness of flumazenil for
treatment of this type of coma.
Although therapeutic hemodialysis
has been previously described, our
case report is strengthened by the
serum concentration monitoring
accompanying it.
CONCLUSIONS: This report
underscores the importance of
initiating gabapentin therapy at low
doses in dialysis- dependent patients
and introduces a novel treatment for
those who experience toxicity.
flumazenil gabapentin
hemodialysis
Due to its lack of significant toxicity,
need for monitoring, and drug
interactions, as well as its rapid onset
of action, gabapentin is now
commonly being used as first-line
therapy for phantom limb pain and
other neuropathic pain syndromes. 1
Although transient somnolence is
relatively common, especially in the
elderly, more serious central nervous
system adverse effects are rare. We
describe an elderly, hemodialysis-
dependent man who became
comatose after a single dose of
gabapentin and the unique treatment
regimen which successfully returned
him to his baseline mental status.
Previous Section
Next Section