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Carbamazepine Poisoning, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Therapeutic uses of carbamazepine:

    • Anticonvulsant

    • Treatment of chronic pain

    • Migraine prophylaxis

    • Mood stabilizer

  • Mechanism:

    • Anticholinergic

    • Similarities to phenytoin and tricyclic antidepre...

Diagnosis

Signs and Symptoms

  • Neurologic manifestations common

  • Cardiotoxicity rare, except in massive overdose

  • CNS:

    • Ataxia

    • Dizziness

    • Drowsiness

    • Nystagmus

    • Hallucinations

    • Combativeness

    • Coma

    • Seizures

  • Respiratory syst...

Treatment

Pre-Hospital

  • Do not administer ipecac.

  • Intubate if significant respiratory depression or airway compromise.

  • Secure IV access.

  • Get complete information about all products potentially ingested.

Initial Stabilization/Therapy

Follow-Up

Disposition

Admission Criteria

  • Decreased mental status at any time, even if resolving (tends to recur with fluctuating drug levels):

    • Observe at least 24 hr for late relapse.

  • Seizures

  • Cardiac dysr...

Pearls and Pitfalls

  • Carbamazepine levels commonly rebound to higher levels during treatment. Obtain serial measurements for severe ingestions.

  • Monitor closely for arrhythmias.

  • Multidose charcoal may be ...

Additional Reading

  • Brahmi  N, Kouraichi  N, Thabet  H, et al. Influence of activated charcoal on the pharmacokinetics and the clinical features of carbamazepine poisoning. Am J Emerg Med.  2006;2...

Codes

ICD9

966.3 Poisoning by other and unspecified anticonvulsants 

ICD10

  • T42.1X1A Poisoning by iminostilbenes, accidental, init

  • T42.1X2A Poisoning by iminostilbenes, intentional self-harm, init

  • T42.1X4A ...

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