Carbamazepine overdose
1
Reactions 476 - 6 Nov 1993 S Carbamazepine overdose Congenital disorders: case report A 44-year-old woman attempted suicide with 24 tablets of carbamazepine 200mg. She was admitted unconscious, with a carbamazepine serum level of 28.5 µg/ml, 6 hours later, and received IV fluids, gastric lavage, and activated charcoal. The woman was 3–4 weeks post-conception at the time of ingestion of the overdose. This period coincided with the closure of the fetal neural tube. A 6-fold elevation in maternal serum α-fetoprotein, drawn at 16 weeks estimated gestational age, was revealed later. Sonographic examination at 20 weeks gestational age revealed a large thoracolumbar spinal defect of approximately 17mm length, and the classic ‘lemon sign’ in the fetal skull, symptomatic of spina bifida. The patient elected to terminate the pregnancy and was admitted for prostaglandin induction 2 days after the sonographic examination. Fetal autopsy revealed a large open myeloschisis with exposed nerve fibers and vertebral bone in the thoracolumbar spine region. The left cerebral hemisphere was markedly hypoplastic. Author comment: It is clinically important to determine the association between carbamazepine and spina bifida because 90-95% of open neural tube defects can be diagnosed prenatally. Available data suggest that only carbamazepine and valproate [valproic acid] pose a risk for neural tube defects. Little BB, et al. Megadose carbamazepine during the period of neural tube closure. Obstetrics and Gynecology 82: 705-708, Part 2, Oct 1993 - USA 800230332 1 Reactions 6 Nov 1993 No. 476 0114-9954/10/0476-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine overdose
Reactions 476 - 6 Nov 1993
SCarbamazepine overdose
Congenital disorders: case reportA 44-year-old woman attempted suicide with 24 tablets of
carbamazepine 200mg. She was admitted unconscious, with acarbamazepine serum level of 28.5 µg/ml, 6 hours later, andreceived IV fluids, gastric lavage, and activated charcoal.
The woman was 3–4 weeks post-conception at the time ofingestion of the overdose. This period coincided with theclosure of the fetal neural tube. A 6-fold elevation in maternalserum α-fetoprotein, drawn at 16 weeks estimated gestationalage, was revealed later. Sonographic examination at 20 weeksgestational age revealed a large thoracolumbar spinal defect ofapproximately 17mm length, and the classic ‘lemon sign’ inthe fetal skull, symptomatic of spina bifida.
The patient elected to terminate the pregnancy and wasadmitted for prostaglandin induction 2 days after thesonographic examination. Fetal autopsy revealed a large openmyeloschisis with exposed nerve fibers and vertebral bone inthe thoracolumbar spine region. The left cerebral hemispherewas markedly hypoplastic.
Author comment: It is clinically important to determine theassociation between carbamazepine and spina bifida because90-95% of open neural tube defects can be diagnosedprenatally. Available data suggest that only carbamazepine andvalproate [valproic acid] pose a risk for neural tube defects.Little BB, et al. Megadose carbamazepine during the period of neural tube closure.Obstetrics and Gynecology 82: 705-708, Part 2, Oct 1993 - USA 800230332
1
Reactions 6 Nov 1993 No. 4760114-9954/10/0476-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
