case_images: PMC9764168_01
case_images: Concentration of topiramate over time of the present case with 3 h of hemodialysis in the first four hours (first two measurements of present case). As a reference case, we used the concentrations reported by Lynch et al., 2010 (no hemodialysis, female patient 37 years of age, unknown weight, 16:15 day 1, 356.6 mug/ml; 09:55 day 2, 173.6 mug/ml; 61.2 and 44.0 mug/ml on the third day of hospitalization at 0841 and 1555, respectively). T0 is time of presentation at the emergency department. Additional to the data in Table 2 (present case), a concentration of 1.1 mg/L was measured at Day 6. The reduction reported by Lynch et al. is 9.3 mg/L/hr (0-order kinetics). As a rough estimation, when this reduction is applied to our case, we would estimate a concentration of 313.5 mg/l - 4.5 hr * 9.3 mg/L/hr = 271.6 mg/L when no hemodialysis was used. The measured concentration of 132.5 mg/L, 4.5 h later after 3 h of dialysis suggests a considerable enhanced clearance, probably around 50% due to hemodialysis.
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case_images: PMC9764168_01_gr1.jpg
case_images: fig0005
case_images: Moreover, drug concentrations pre- and post-dialysis of venlafaxine and quetiapine are provided (Table 2 and Fig. 1). The initial 61 unique hits were screened based on title and abstract; 23 were categorized as eligible, and a total of 38 articles were excluded because they did not match eligibility criteria for various reasons (see Fig. 2 and Supplemental Digital Content 1).
case_images: Flowchart of search, selection and review process. The used search strategy was: (topiramate [Supplementary Concept] OR Topiramate [Title/Abstract]) AND ("suicide" [MeSH Terms] OR "drug overdose" [MeSH Terms] OR intoxication)). Overview of excluded articles are provided in supplemental digital content 1.
case_images: gr2.jpg
case_images: PMC9764168_01_gr2.jpg
case_images: fig0010
case_images: The latest PubMed database search update was on 17 September 2021 (see Fig. 2, the flowchart of the search, selection and review process). The initial 61 unique hits were screened based on title and abstract; 23 were categorized as eligible, and a total of 38 articles were excluded because they did not match eligibility criteria for various reasons (see Fig. 2 and Supplemental Digital Content 1).