Reactions 1165 - 18 Aug 2007

O SCarbamazepine overdose

Coma and seizures: case reportA 25-year-old man with borderline personality disorder

developed coma and seizures after intentionally ingesting anoverdose of slow-release carbamazepine and paroxetine.

The man was currently receiving lithium, paroxetine andrisperidone for borderline personality disorder, which hadpreviously been treated with carbamazepine. After ingestingslow-release carbamazepine 20g and paroxetine 400mg, hevomited and became drowsy, and then lost consciousness. Enroute to hospital, he experienced three episodes of generalisedtonic-clonic seizures, which resolved spontaneously. Onadmission 16 hours postingestion, he was unconscious andonly responsive to deep pain, both pupils were dilated, his BPwas 110/70mm Hg and his HR was 113 beats/min. An ECGrevealed sinus tachycardia and laboratory testing showedleucocytosis and an elevated creatine kinase level. His serumcarbamazepine concentration was 52.08 µg/mL.

The man was intubated and mechanically ventilated. Hereceived multiple doses of activated charcoal (MDAC) via anasogastric tube. A 4-hour charcoal haemoperfusion wasstarted 22 hours postingestion. On completion, his serumcarbamazepine concentration was 27.16 µg/mL and he washaemodynamically stable. Further haemoperfusion was notpossible as he developed thrombocytopenia, which resolvedwithin 48 hours without a platelet transfusion. MDAC wascontinued due to his toxic serum carbamazepineconcentration; however, at 58 hours postingestion his serumcarbamazepine concentration had rebounded to 32.36 µg/mL,possibly indicating a bezoar. Whole body irrigation wasperformed over 10 hours. During this period, hiscarbamazepine concentration increased to 38.5 µg/mL and oncompletion, he experienced repeated episodes of generalisedseizures and received midazolam and phenytoin. MDAC wasthen restarted and continued until 5 days postingestion; at thispoint, his serum carbamazepine concentration was in thetherapeutic range (1.09 µg/mL). His hospital stay wascomplicated by hyponatraemia, Gram-negative aspirationpneumonia and sepsis. He was discharged 15 dayspostadmission without sequelae.

Author comment: "We report on a patient with severeoverdose of slow-release carbamazepine who experiencedonly limited improvement with MDAC and [whole bodyirrigation]."Lurie Y, et al. Limited efficacy of gastrointestinal decontamination in severe slow-release carbamazepine overdose. Annals of Pharmacotherapy 41: 1539-1543, No.9, Sep 2007 - Israel 801069848

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Reactions 18 Aug 2007 No. 11650114-9954/10/1165-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved