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

Abstract

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.

The Use of Herbal Products/Dietary Supplements and Affecting Factors in Patients Applying to a Pediatric Neurology Outpatient Clinic: A Descriptive Questionnaire Study

“…Despite the treatment applied, it was observed that the carbamazepine level was still high (31.8 mg/L) in the measurements taken after 12 hours. High plasma concentration of carbamazepine despite the treatment applied in this case report was associated with the use of the drug together with grapefruit juice [37]. In a case series, four patients with a history of sertraline use were reported to develop serotonin syndrome within 2 to 4 days following the use of 300 mg St. John's wort two or three times a day [38].…”