Reactions 503 - 28 May 1994

SCarbamazepine overdose

Liver and GI disorders: case reportThe following case illustrates that in carbamazepine

overdose, particularly with slow-release preparations, seriousadverse effects may have a late onset and a prolonged course.

A 43-year-old woman with bipolar disorder took 20g ofcarbamazepine [Neurotop retard®; Gerot-Pharmazeutika]during a psychotic episode one evening. She was found thefollowing morning and admitted to hospital. The patient wassomnolent and unresponsive and her GI peristalsis wasreduced. Her serum carbamazepine level was 123 µmol/L onadmission.

The patient received gastric lavage, activated charcoal andoral mannitol and remained on artificial respiration for 4 days.She was given pyridostigmine but had no bowel motion. Onthe second day an x-ray confirmed the diagnosis of adynamicileus. Distigmine was given and on the third day, bowelsounds were audible. However, a bowel motion was notproduced until day 6. The woman’s bilirubin level was 3.3 mg/dl on day 4. Her serum carbamazepine level decreased on thesecond day but increased to 70 µmol/L on the fourth and fifthday before decreasing to undetectable levels on day 11.

Author comment: In this patient, the ileus, either inducedby paralysis or by mechanical obstruction with tabletconglomerates, was resistant to therapy for several days. Inaddition, the hepatotoxicity of carbamazepine may haveimpaired metabolism.Baischer W, et al. Carbamazepine poisoning: protracted course with developmentof gastrointestinal atony and hepatotoxicity. Wiener Klinische Wochenschrift 106:27-29, No. 1, 1994 [Translated from the original published in German] -Austria 807045064

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Reactions 28 May 1994 No. 5030114-9954/10/0503-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved