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