Carbamazepine toxicity: Difference between revisions
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==Background== | ==Background== | ||
*Has [[Anticholinergic Toxicity|anticholinergic]] and antiepileptic effects | *Has [[Anticholinergic Toxicity|anticholinergic]], sodium-channel blockade, anti-NMDA and antiepileptic effects | ||
*Therapeutic concentration: 4-12 | *Therapeutic concentration: 4-12 mg/L | ||
== Clinical Features == | ==Clinical Features== | ||
''May be delayed and follow crescendo-decrescendo course (due to delayed GI motility)'' | |||
*Neurologic | |||
* | **[[Ataxia ]] | ||
**Ataxia | |||
**Nystagmus | **Nystagmus | ||
**Coma | **[[Seizures]] | ||
**[[Coma ]] | |||
*[[Anticholinergic Toxicity]] | *[[Anticholinergic Toxicity]] | ||
* | *Cardiovascular | ||
**Dysrhythmias are rare but may occur | **Dysrhythmias are rare but may occur | ||
** | **[[Wide QRS]] from sodium channel blockade<ref>Novartis Pharmaceuticals USA. Prescribing information for Tegretol CR400(R) tablets www.pharma.us.novartis.com/product/pi/pdf/tegretol.pdf (Accessed on August 27, 2008).</ref> | ||
**QT | **[[QT Prolongation]] | ||
==Differential Diagnosis== | |||
== | ==Evaluation== | ||
*Levels do not accurately correlate | *Levels do not accurately correlate with clinical severity | ||
== | ==Management== | ||
*GI | *GI decontamination | ||
**[[Activated Charcoal]] (if presents | **[[Activated Charcoal]] (if presents within 1hr of ingestion) | ||
*Dialysis | **Consider [[Multidose activated charcoal]] | ||
*[[Dialyzable Drugs|Dialysis]] for severe cases. Indications: <ref>Ghannoum M, Yates C, Galvao TF et al. Extracorporeal treatment for carbamazepine poisoning: Systematic review and recommendations from the EXTRIP workgroup. Clin Tox 2016. 52(10):993-1004.</ref> | |||
**Intractable seizures or life threatening dysrhythmia (level 1D recommendation) | |||
**Respiratory depression requiring mechanical ventilation or prolonged coma (level 2D suggestion) | |||
**Significant toxicity or rising/persistent carbamazepine level despite [[activated charcoal]] and supportive care (level 2D suggestion) | |||
==Disposition== | ==Disposition== | ||
*Consider | *Consider discharge for patient with decreasing levels (measured few hrs apart) and is asymptomatic | ||
==See Also== | |||
*[[Toxicology (main)]] | |||
*[[Carbamazepine]] | |||
==References== | |||
<references/> | |||
[[Category: | [[Category:Toxicology]] | ||
Latest revision as of 23:35, 11 February 2021
Background
- Has anticholinergic, sodium-channel blockade, anti-NMDA and antiepileptic effects
- Therapeutic concentration: 4-12 mg/L
Clinical Features
May be delayed and follow crescendo-decrescendo course (due to delayed GI motility)
- Neurologic
- Anticholinergic Toxicity
- Cardiovascular
- Dysrhythmias are rare but may occur
- Wide QRS from sodium channel blockade[1]
- QT Prolongation
Differential Diagnosis
Evaluation
- Levels do not accurately correlate with clinical severity
Management
- GI decontamination
- Activated Charcoal (if presents within 1hr of ingestion)
- Consider Multidose activated charcoal
- Dialysis for severe cases. Indications: [2]
- Intractable seizures or life threatening dysrhythmia (level 1D recommendation)
- Respiratory depression requiring mechanical ventilation or prolonged coma (level 2D suggestion)
- Significant toxicity or rising/persistent carbamazepine level despite activated charcoal and supportive care (level 2D suggestion)
Disposition
- Consider discharge for patient with decreasing levels (measured few hrs apart) and is asymptomatic
See Also
References
- ↑ Novartis Pharmaceuticals USA. Prescribing information for Tegretol CR400(R) tablets www.pharma.us.novartis.com/product/pi/pdf/tegretol.pdf (Accessed on August 27, 2008).
- ↑ Ghannoum M, Yates C, Galvao TF et al. Extracorporeal treatment for carbamazepine poisoning: Systematic review and recommendations from the EXTRIP workgroup. Clin Tox 2016. 52(10):993-1004.