1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-6-70-b 10.15844/pedneurbriefs-6-9-9 Antiepileptic Drugs Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Carbamazepine Acute Toxicity http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 09 1992 01 07 2016 6 9 70 71 Copyright: © 1992 The Author(s) 1992 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Acute toxic reaction to carbamazepine: clinical effects and serum concentrations

The clinical toxic effects and serum concentrations after ingestion of carbamazepine are reported in 82 pediatric patients from the Intensive Care Unit, Royal Children’s Hospital, Melbourne, Australia.

 Carbamazepine Myocardial Drowsiness

The clinical toxic effects and serum concentrations after ingestion of carbamazepine are reported in 82 pediatric patients from the Intensive Care Unit, Royal Children’s Hospital, Melbourne, Australia. Two died, 1 of cardiac failure and 1 of aspiration pneumonitis with septicemia. In 10 patients in deep coma with a Glasgow Coma Scale (GCS) of 3-4, the mean serum level was 213 umol/L. The serum carbamazepine level was related to the depth of coma, convulsions, hypotension caused by myocardial failure and conduction defects, and to the requirement for mechanical ventilation. In 27 patients with moderate coma (GCS 5-8) the mean serum level of carbamazepine was 112 umol/L; convulsions occurred in 2 patients in this group. In 45 patients with mildly depressed consciousness (GCS 9-15) the serum level was 73 umol/L and symptoms included drowsiness (80%), ataxia (53%), nystagmus (38%), vomiting (17%), and dystonia (7%). Patients with carbamazepine serum levels greater than 150 umol/L may require intensive life support. [1]

COMMENT. In a study from the University of Cincinnati, Ohio, the administration of activated charcoal resulted in a statistically significant reduction in carbamazepine half-life but the time to complete recovery from overdose was not affected [2]. The authors recommend no more than 2 to 3 doses (1 gram per kilogram) of activated charcoal in order to prevent formation of concretions and continued absorption of the drug. Prolonged repeated use of activated charcoal after carbamazepine overdose in comatose patients is not beneficial and carries a hazard of aspiration.

 Tibballs J Acute toxic reaction to carbamazepine: clinical effects and serum concentrations J Pediatr 1992 Aug 121 2 295 299 10.1016/S0022-3476(05)81208-9 1640302 Wason S Baker RC Carolan P Seigel R Druckenbrod RW Carbamazepine overdose - the effects of multiple dose activated charcoal Clin Toxicol 1992 30 1 39 48 10.3109/15563659208994444 1542148