An Unusual Case of Carbamazepine Poisoning with a Near-Fatal Relapse after Two Days

Zeeuw, Rokus A. de; Westenberg, H.G.M.; Kleijn, Eppo van der; Gimbrère, J.S.F.

doi:10.3109/15563657908992443

Cited by 40 publications

(13 citation statements)

References 5 publications

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“…The combination of CBZ and grapefruit juice could result in an extended period of elevated blood CBZ concentration, highlighting the need to suppress any future increases in the CBZ concentration. Although the peak blood CBZ concentration typically appears 6–24 h after ingesting a normal therapeutic dose, a massive overdose may delay the peak concentration until more than 72 h after ingestion . In cases of CBZ overdose, blood CBZ concentrations have also been known to continue rising after the initial measurement .…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of a case with concurrent ingestion of carbamazepine overdose and grapefruit juice

Mochizuki

Hamano

Miyama

et al. 2015

Acute Medicine & Surgery

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Case: We report a case with concurrent ingestion of carbamazepine (CBZ) overdose and grapefruit juice. A 23-year-old man, with a history of epilepsy, was admitted to our emergency department 2 h after ingesting 10 g CBZ with 1 L grapefruit juice. On arrival, the patient's Glasgow Coma Scale score was 9 and he showed signs of restlessness. Grapefruit juice-like gastric fluid, with tablet residue, was observed in his stomach after we inserted a gastric tube. Our initial test detected a blood CBZ level of 41.5 mg/L. Outcome:We treated the patient with gastric lavage, activated charcoal, and charcoal hemoperfusion. His blood CBZ level began to decrease after gastrointestinal decontamination, and he was discharged without any sequelae on day 9. Conclusion:Gastric lavage or aspiration may be considered in cases where drug residue is found in the stomach, especially if materials are involved that might exacerbate the drug's toxicity.

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Section: Discussionmentioning

confidence: 99%

Successful treatment of a case with concurrent ingestion of carbamazepine overdose and grapefruit juice

Mochizuki

Hamano

Miyama

et al. 2015

Acute Medicine & Surgery

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“…This can lead to hyperammonemia, hepatitis, pancreatitis, and renal insufficiency. 9 Although the mechanism of action for Li has not been completely elucidated, recent research suggests that the therapeutic action of Li results from a complex interaction of events affecting multiple target sites. These interacting systems likely readjust the balance between excitatory and inhibitory activities, whereas the decrease in glutamatergic activity may contribute to its neuroprotection.…”

Section: Discussionmentioning

confidence: 99%

The Toxic Trio

Karydes

Meehan

Bryant

2014

American Journal of Therapeutics

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Patients with altered mental status and seizure or psychiatric disease often present with an unclear medication history. Commonly prescribed medications include valproic acid (VPA), lithium (Li), or carbamazepine (CZN) of which the regional poison center (RPC) often recommends obtaining these serum concentrations. Regularly ruling out supratherapeutic concentrations without a known history of ingestion may help direct care. Cases from the RPC coded as VPA, Li, and CZN, from January 1, 2006 to December 31, 2008, were searched. All patients with supratherapeutic concentrations (VPA >100 μg/mL, Li >1.2 mEq/L, and CZN >12 μg/mL) were evaluated for the following criteria: (1) those with altered mental status and an unclear history of seizure or psychiatric disorder and (2) a mediation profile not including VPA, Li, or CZN. Twenty-six patients met the inclusion criteria: 8 patients in the VPA group (113-247 μg/mL; mean, 158), 9 patients in the Li group (1.9-5.2 mEq/L; mean, 2.9), and 9 patients in the CZN group (13.4-38.8 μg/mL; mean, 23.2). All patients survived and were treated with supportive care; however, 1 patient had a Li level of 5.2 mEq/L and received hemodialysis. In altered patients potentially being treated for seizure or psychiatric disorders and unknown ingestions or medication lists, obtaining concentrations of VPA, Li, and CZN may help direct care and provide clinically relevant information. The RPC detected 26 patients with supratherapeutic VPA, Li, or CZN concentrations in patients with potential indications for the agent but no available history of drug ingested or medication list. A prospective study is warranted to evaluate the usefulness of obtaining these concentrations in this patient population.

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“…Prolonged cyanosis in dapsone toxicity (Elonen et al 1979;Neuvonen et al 1983) and relapsing obtundation in carbamazepine overdose (De Zeeuw et al 1979) have been attributed to enterohepatic reabsorption of both the parent compounds and their metabolites.…”

Section: Absorptionmentioning

confidence: 99%

Pharmacokinetics of Drugs in Overdose

Sue

Shannon

1992

Clinical Pharmacokinetics

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The pharmacokinetics of drugs may be altered following an overdose. The degree of absorption depends on the physical characteristics of the drug; the rate of dissolution may delay or broaden peak serum concentrations. The pathophysiological effects of a drug may also limit or augment absorption. Altered distribution of drugs in overdose results from changes in the extent of protein binding and size of the volume of distribution. Saturation of hepatic enzyme systems in overdose is manifested by delayed metabolism or elimination of many drugs; renal elimination of unchanged drug may take on greater importance in this instance. Familiarity with the toxicokinetic profile of a given drug enables the physician to exploit these principles in order to limit toxicity. Delayed or prolonged absorption allows for late decontamination. Multiple doses of activated charcoal are effective in interrupting both entero-enteric and enterohepatic recirculation. Alkalinisation-induced ion trapping enhances renal elimination of unchanged drugs which normally undergo hepatic transformation. For several drugs, chronic overdose due to altered distribution is associated with a greater severity of toxic manifestations despite relatively low serum drug concentrations. Conversely, with some drugs, induction of metabolic pathways may lead to more rapid drug elimination in chronic overdose. Knowledge of the pharmacokinetic alterations which occur in drug overdose enables the physician to predict toxicity with greater accuracy and to institute optimum therapy in a timely manner.

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An Unusual Case of Carbamazepine Poisoning with a Near-Fatal Relapse after Two Days

Cited by 40 publications

References 5 publications

Successful treatment of a case with concurrent ingestion of carbamazepine overdose and grapefruit juice

Successful treatment of a case with concurrent ingestion of carbamazepine overdose and grapefruit juice

The Toxic Trio

Pharmacokinetics of Drugs in Overdose

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