Reactions 1148 - 21 Apr 2007

O SCarbamazepine overdose

Unconsciousness: 3 case reportsThree patients were found unconscious after ingesting

overdoses of carbamazepine and were treated successfullywith haemodialysis (patients 1 and 3) or haemoperfusion(patient 2).

Patient 1, a 14-year-old boy, was admitted to a paediatricemergency department 12 hours after ingesting20 carbamazepine 300mg tablets. He was unconscious andunresponsive to verbal commands and he had a bloodcarbamazepine level of 22.5 µg/mL. Before admission, he hadundergone gastric lavage and received activated charcoal. Heunderwent haemodialysis and, after a 3-hour session, he wasconscious and alert. His blood carbamazepine concentrationimmediately after haemodialysis was 15.5 µg/mL and graduallydecreased to 11.0 µg/mL at 6 hours. On the third day ofhospitalisation, he was discharged.

Patient 2, a 13-year-old girl, was found in an unconsciousstate and subsequently received gastric lavage and activatedcharcoal at a primary care centre. She was admitted to apaediatric emergency department 9 hours after ingesting atleast 12 carbamazepine 400mg tablets. On admission, sheresponded to verbal and noxious stimuli and had a bloodcarbamazepine concentration of 34 µg/mL. She underwent3 hours of charcoal haemoperfusion and, immediatelyafterwards, her blood carbamazepine concentration was26.7 µg/mL and gradually decreased to 7.7 µg/mL after24 hours. On hospital day 4, she was discharged.

Patient 3, a 12-year-old girl, had been prescribed phenytoinand carbamazepine for epilepsy. She had stopped taking herdrugs for the last 15 days. She was found unconscious in atonic posture in bed. On the way to hospital, she had twogeneralised tonic-clonic seizures lasting a few minutes. In theemergency department, she was unconscious with pinpointpupils which were unresponsive to light. She responded topainful stimuli. Upon further investigation, her parentsrevealed that 14 carbamazepine tablets were missing(140 mg/kg). Her blood carbamazepine concentration was20 µg/mL and she underwent haemodialysis. Within 6 hoursfollowing haemodialysis, her blood carbamazepineconcentration was non-toxic at 11.1 µg/mL.Bek K, et al. Carbamazepine poisoning managed with haemodialysis andhaemoperfusion in three adolescents. Nephrology 12: 33-35, No. 1, Feb 2007 -Turkey 801072042

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Reactions 21 Apr 2007 No. 11480114-9954/10/1148-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved