Carbamazepine toxicity

Background

• Has anticholinergic and antiepileptic effects
• Therapeutic concentration: 4-12 mg/L

Clinical Features

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

Evaluation

• Levels do not accurately correlate with clinical severity

Management

• GI detox
  • Activated Charcoal (if presents within 1hr of ingestion)
• Dialysis is effective (if needed)

Disposition

• Consider discharge for patient with decreasing levels (measured few hrs apart) and is asymptomatic