Related Experiment Videos
Signs and symptoms of carbamazepine overdose in young children
M Lifshitz1, V Gavrilov, S Sofer
1Toxicology Unit, Soroka University Medical Center, Beer-Sheva, Israel. matyl@bgumail.bgu.ac.il
Insights
In young children, nystagmus is the most common sign of carbamazepine (CBZ) overdose, often accompanied by drowsiness or ataxia. This finding aids in diagnosing CBZ toxicity in pediatric patients with unknown central nervous system depression.
Area of Science:
- Pediatric Toxicology
- Clinical Pharmacology
- Emergency Medicine
Background:
- Accidental carbamazepine (CBZ) poisoning is a concern in young children.
- Identifying early signs of mild to moderate CBZ overdose is crucial for timely intervention.
Purpose of the Study:
- To identify and describe the common clinical manifestations of mild to moderate carbamazepine (CBZ) overdose in pediatric patients.
- To establish key diagnostic indicators for carbamazepine toxicity in young children.
Main Methods:
- Retrospective analysis of medical records of children under 5 years with acute accidental CBZ poisoning.
- Evaluation of serum CBZ levels, clinical signs and symptoms, and laboratory findings.
- Data collected from pediatric admissions between 1993 and 1998.
Main Results:
- 14 children under 5 years experienced accidental CBZ poisoning.
- Nystagmus (8/14) and drowsiness (8/14) were the most frequent signs, followed by ataxia (4/14).
- Peak serum CBZ levels ranged from 18 to 32 microg/ml (mean 25 microg/ml), significantly above the therapeutic range (5-10 microg/ml).
Conclusions:
- Nystagmus is the most common presenting sign of mild to moderate carbamazepine overdose in young children.
- Drowsiness and ataxia are also frequent symptoms associated with pediatric CBZ toxicity.
- The presence of nystagmus and central nervous system depression of unknown origin in a child warrants consideration of carbamazepine poisoning.
Objective:
To examine common signs and symptoms of mild to moderate carbamazepine (CBZ) overdose in young children.
Methods:
The medical records of previously healthy children admitted to the pediatric departments for acute accidental CBZ poisoning during the years 1993-1998 were evaluated retrospectively. Information was retrieved on serum CBZ levels, signs and symptoms on admission and during hospitalization, ECG findings, and chemical laboratory test.
Results:
There were 14 exposed children all under the age of 5 years. These children accidentally took CBZ prescribed for a family member. The diagnosis of CBZ poisoning in seven children was unknown on admission because of inadequate history and was revealed only on toxicology screen. Nystagmus and drowsiness occurred in 8 of the 14 children, nystagmus and ataxia in 4 children, and drowsiness and tachycardia in another 2 children. The peak CBZ serum levels in these children ranged from 18 microg/ml to 32 microg/ml, mean + SD; 25 microg/ml + 4.64 microg/ml (therapeutic range: 5-10 microg/ml).
Conclusion:
Based on a certain group of young pediatric patients with mild to moderate CBZ poisoning, it is concluded that, nystagmus is the most common sign of this overdose. Other common signs are drowsiness and ataxia. The presence of nystagmus and CNS depression of unknown etiology, in a young child should suggest the possibility of CBZ toxicity.