Carbamazepine overdose
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Reactions 1509, p11-12 - 12 Jul 2014 O S Carbamazepine overdose Carbamazepine toxicity: case report A 31-year-old woman developed carbamazepine toxicity after ingesting an overdose of carbamazepine [Tegretol CR]. The woman, who had a history of bipolar disorder, was prescribed an extended-release carbamazepine preparation for the first time. The following evening, after an altercation with a friend, she ingested approximately 50 carbamazepine tablets (10g). She was found with slurred speech 2 hours later, and presented at the emergency department. She was drowsy, but her vital signs were stable; she received oral activated charcoal. However, she developed hypotension and respiratory failure and became more obtunded; she received intubation and mechanical ventilation. Her carbamazepine concentration was 22 µg/mL, and she had mild leucocytosis. The woman received IV fluids and forced alkaline diuresis. However, she was unresponsive, and her carbamazepine concentration had increased to 26 ´ ug/mL 20 hours after ingestion, suspected to be due to ongoing absorption from the extended-release preparation. She commenced continuous venovenous haemodiafiltration with added albumin. Although her carbamazepine concentration remained unchanged 3 hours later, the concentration fell over the following 24 hours. By hospital day 2, her carbamazepine concentration was <15 µg/mL. She woke up and was extubated, but dialysis was continued until her carbamazepine concentration was 10 µg/mL. She was subsequently discharged, with stable vital signs and neurologically intact. Author comment: "Carbamazepine overdose is a common, toxic ingestion, manifesting as central nervous system (CNS) and respiratory depression." "More severe cases of toxic ingestion with carbamazepine resulting in hypotension, respiratory and central nervous system depression require therapies to increase drug removal." Narayan R, et al. Successful treatment of severe carbamazepine toxicity with 5% albumin-enhanced continuous venovenous hemodialysis. Journal of Artificial Organs 17: 206-209, No. 2, Jun 2014. Available from: URL: http:// doi.org/10.1007/s10047-014-0754-4 - USA 803105760 1 Reactions 12 Jul 2014 No. 1509 0114-9954/14/1509-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine overdose
Reactions 1509, p11-12 - 12 Jul 2014
O SCarbamazepine overdose
Carbamazepine toxicity: case reportA 31-year-old woman developed carbamazepine toxicity
after ingesting an overdose of carbamazepine [Tegretol CR].The woman, who had a history of bipolar disorder, was
prescribed an extended-release carbamazepine preparationfor the first time. The following evening, after an altercationwith a friend, she ingested approximately 50 carbamazepinetablets (10g). She was found with slurred speech 2 hours later,and presented at the emergency department. She was drowsy,but her vital signs were stable; she received oral activatedcharcoal. However, she developed hypotension andrespiratory failure and became more obtunded; she receivedintubation and mechanical ventilation. Her carbamazepineconcentration was 22 µg/mL, and she had mild leucocytosis.
The woman received IV fluids and forced alkaline diuresis.However, she was unresponsive, and her carbamazepineconcentration had increased to 26 ug/mL 20 hours afteringestion, suspected to be due to ongoing absorption from theextended-release preparation. She commenced continuousvenovenous haemodiafiltration with added albumin. Althoughher carbamazepine concentration remained unchanged3 hours later, the concentration fell over the following24 hours. By hospital day 2, her carbamazepine concentrationwas <15 µg/mL. She woke up and was extubated, but dialysiswas continued until her carbamazepine concentration was10 µg/mL. She was subsequently discharged, with stable vitalsigns and neurologically intact.
Author comment: "Carbamazepine overdose is acommon, toxic ingestion, manifesting as central nervoussystem (CNS) and respiratory depression." "More severe casesof toxic ingestion with carbamazepine resulting inhypotension, respiratory and central nervous systemdepression require therapies to increase drug removal."Narayan R, et al. Successful treatment of severe carbamazepine toxicity with 5%albumin-enhanced continuous venovenous hemodialysis. Journal of ArtificialOrgans 17: 206-209, No. 2, Jun 2014. Available from: URL: http://doi.org/10.1007/s10047-014-0754-4 - USA 803105760
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Reactions 12 Jul 2014 No. 15090114-9954/14/1509-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved
