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Acute felbamate overdose with crystalluria
Kathryn H Meier1, Kent R Olson, Jean L Olson
1California Poison Control System, Department of Clinical Pharmacy, University of California, San Francisco, CA 94143-1369, USA. kmpcc@itsa.ucsf.edu
Clinical Toxicology (Philadelphia, Pa.)
|May 21, 2005
Summary
A child experienced felbamate toxicity symptoms including vomiting and ataxia after ingesting a large dose of the drug. Urine analysis revealed characteristic felbamate crystals, which resolved with hydration.
Area of Science:
- Pediatric Toxicology
- Clinical Pharmacology
- Urine Analysis
Background:
- Felbamate is an anticonvulsant medication used to treat epilepsy.
- Overdose can lead to significant adverse effects.
- Understanding drug metabolism and excretion is crucial for managing toxicity.
Observation:
- A 3-year-old child presented with vomiting, ataxia, and crystalluria after ingesting 232 mg/kg of felbamate elixir.
- Microscopy identified sharp, needle-like crystals in the urine.
- Serum felbamate levels were elevated at 138 mg/L 15 hours post-ingestion.
Findings:
- Urine crystals were primarily composed of unchanged felbamate (80.9%) and monocarbamate felbamate (18.8%).
- Trace amounts of mercapturic acid conjugates of 2-phenylpropenal were also detected.
- The crystalluria and hematuria resolved within 24 hours following intravenous fluid therapy.
Implications:
- This case highlights the potential for felbamate crystalluria and associated symptoms in overdose scenarios.
- Prompt fluid resuscitation is effective in managing felbamate-induced renal toxicity.
- Analysis of urine crystals can aid in diagnosing and monitoring drug toxicity.