Carbamazepine
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Reactions 746 - 10 Apr 1999 S Carbamazepine Hepatic encephalopathy in a child: case report A 9-year-old girl developed hepatic encephalopathy during treatment with carbamazepine 500 mg/day for tonic-clonic seizures secondary to severe perinatal asphyxia. After 5 months’ treatment with carbamazepine, the girl was admitted to hospital with persistent vomiting, fever, headache, jaundice and elevated serum liver enzyme levels. The following day she had a headache and hyperemesis and began treatment for hepatic encephalopathy with an enema and neomycin. Over the next 4 days, she exhibited hypoprothrombinaemia, elevated serum ammonia levels, asterixis and lethargy. Histological examination of a liver biopsy showed hepatocyte necrosis with inflammatory infiltration of mononuclear and polymorphonuclear cells. Carbamazepine was stopped. After treatment with prednisone, the girl’s prothrombin levels began to increase and her bilirubin levels decreased. Prednisone was tapered and discontinued after approximately 2 months. One year later, the girl had no evidence of liver damage. Author comment: ‘Carbamazepine-induced hepatitis is well documented in the literature. Suspicion of a drug-related etiology in this patient grew only after many days, probably because it is not commonly seen in children.’ Morales-Diaz M, et al. Suspected carbamazepine-induced hepatotoxicity. Pharmacotherapy 19: 252-255, Feb 1999 - Chile 800745845 1 Reactions 10 Apr 1999 No. 746 0114-9954/10/0746-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 746 - 10 Apr 1999
SCarbamazepine
Hepatic encephalopathy in a child: case reportA 9-year-old girl developed hepatic encephalopathy during
treatment with carbamazepine 500 mg/day for tonic-clonicseizures secondary to severe perinatal asphyxia.
After 5 months’ treatment with carbamazepine, the girl wasadmitted to hospital with persistent vomiting, fever, headache,jaundice and elevated serum liver enzyme levels. Thefollowing day she had a headache and hyperemesis and begantreatment for hepatic encephalopathy with an enema andneomycin. Over the next 4 days, she exhibitedhypoprothrombinaemia, elevated serum ammonia levels,asterixis and lethargy. Histological examination of a liverbiopsy showed hepatocyte necrosis with inflammatoryinfiltration of mononuclear and polymorphonuclear cells.
Carbamazepine was stopped. After treatment withprednisone, the girl’s prothrombin levels began to increaseand her bilirubin levels decreased. Prednisone was taperedand discontinued after approximately 2 months. One yearlater, the girl had no evidence of liver damage.
Author comment: ‘Carbamazepine-induced hepatitis is welldocumented in the literature. Suspicion of a drug-relatedetiology in this patient grew only after many days, probablybecause it is not commonly seen in children.’Morales-Diaz M, et al. Suspected carbamazepine-induced hepatotoxicity.Pharmacotherapy 19: 252-255, Feb 1999 - Chile 800745845
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Reactions 10 Apr 1999 No. 7460114-9954/10/0746-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
