Carbamazepine toxicity

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Background

  • Has anticholinergic in addition to antiepileptic effects
  • Therapeutic concentration: 4-12

Clinical Features

  • May be delayed and follow crescendo-decrescendo course (due to delayed GI motility)
  • CNS
    • Ataxia
    • Nystagmus
    • Coma
  • Anticholinergic toxidrome
  • CV
    • Dysrhythmias are rare but may occur
    • Widened QRS

Diagnosis

  • Levels do not accurately correlate w/ clinical severity

Treatrment

  • GI detox
    • Activated charcoal (if presents w/in 1hr of ingestion)
  • Dialysis is effective (if needed)

Disposition

  • Consider d/c for pt with decreasing levels (measured few hrs apart) and is asymptomatic

Source

  • Tintinalli
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