Carbamazepine overdose
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Reactions 1132 - 16 Dec 2006 O S Carbamazepine overdose Drowsiness, coma and delirium: case report A 29-year-old woman developed increasing drowsiness, coma and subsequent delirium following an overdose of carbamazepine. The woman, who had absconded from a psychiatric hospital, was brought to an emergency department (ED) 1 hour after ingesting 200 controlled-release tablets of carbamazepine 200mg (a total of 400mg/kg). She was monitored in the ED and, over the following few hours, she developed increasing drowsiness; her Glasgow Coma Score decreased to 12/15. The woman underwent rapid induction of anaesthesia and endotracheal intubation. Her BP just prior to intubation was 90/60mm Hg; she responded to a bolus of normal saline. She received activated charcoal via her nasogastric tube, which was then prescribed 4 hourly. She was admitted to the ICU and received ventilation and supportive care. Her serum carbamazepine concentration peaked at 41 mg/L at 36 hours and remained > 30 mg/L over the following week; during that time, she remained unresponsive without sedation. Ongoing absorption of carbamazepine appeared to match elimination. She received a small dose of norepinephrine [noradrenaline] to maintain an adequate BP. On day 7, her bowel sounds were lost and she developed a degree of abdominal distension. Multidose activated charcoal treatment was discontinued and, due to her persistently increased carbamazepine concentration, she began receiving a charcoal haemoperfusion. As her carbamazepine levels fell to within the normal therapeutic range, she regained consciousness. Cardiotonics were withdrawn successfully. She developed agitated delirium that was controlled with diazepam. Her progress was complicated by continued abdominal distension; clinical and radiological assessment revealed a complete small-intestinal obstruction. She underwent a laparotomy which revealed a large charcoal concretion that was obstructing her ileum and she required an ileostomy. She underwent extubation on post-overdose day 12 [patient outcome not stated]. Soderstrom J, et al. Toxicology case of the month: carbamazepine overdose. Emergency Medicine Journal 23: 869-871, No. 11, Nov 2006 - Australia 801054520 1 Reactions 16 Dec 2006 No. 1132 0114-9954/10/1132-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine overdose
Reactions 1132 - 16 Dec 2006
O SCarbamazepine overdose
Drowsiness, coma and delirium: case reportA 29-year-old woman developed increasing drowsiness,
coma and subsequent delirium following an overdose ofcarbamazepine.
The woman, who had absconded from a psychiatrichospital, was brought to an emergency department (ED)1 hour after ingesting 200 controlled-release tablets ofcarbamazepine 200mg (a total of 400mg/kg). She wasmonitored in the ED and, over the following few hours, shedeveloped increasing drowsiness; her Glasgow Coma Scoredecreased to 12/15.
The woman underwent rapid induction of anaesthesia andendotracheal intubation. Her BP just prior to intubation was90/60mm Hg; she responded to a bolus of normal saline. Shereceived activated charcoal via her nasogastric tube, whichwas then prescribed 4 hourly. She was admitted to the ICUand received ventilation and supportive care. Her serumcarbamazepine concentration peaked at 41 mg/L at 36 hoursand remained > 30 mg/L over the following week; during thattime, she remained unresponsive without sedation. Ongoingabsorption of carbamazepine appeared to match elimination.She received a small dose of norepinephrine [noradrenaline] tomaintain an adequate BP. On day 7, her bowel sounds werelost and she developed a degree of abdominal distension.Multidose activated charcoal treatment was discontinued and,due to her persistently increased carbamazepineconcentration, she began receiving a charcoalhaemoperfusion. As her carbamazepine levels fell to within thenormal therapeutic range, she regained consciousness.Cardiotonics were withdrawn successfully. She developedagitated delirium that was controlled with diazepam. Herprogress was complicated by continued abdominal distension;clinical and radiological assessment revealed a completesmall-intestinal obstruction. She underwent a laparotomywhich revealed a large charcoal concretion that wasobstructing her ileum and she required an ileostomy. Sheunderwent extubation on post-overdose day 12 [patientoutcome not stated].Soderstrom J, et al. Toxicology case of the month: carbamazepine overdose.Emergency Medicine Journal 23: 869-871, No. 11, Nov 2006 -Australia 801054520
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Reactions 16 Dec 2006 No. 11320114-9954/10/1132-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
