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Pediatric carbamazepine intoxication
E S Stremski1, W B Brady, K Prasad
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA.
Insights
Pediatric carbamazepine ingestion can cause dystonic reactions, coma, and apnea, especially with high serum levels. Multiple doses of activated charcoal effectively reduce carbamazepine half-life in children.
Area of Science:
- Toxicology
- Pediatric Emergency Medicine
- Clinical Pharmacology
Background:
- Carbamazepine is a commonly prescribed anticonvulsant and mood-stabilizing medication.
- Overdoses in pediatric populations can lead to significant toxicity.
- Understanding the clinical manifestations and management of carbamazepine ingestion is crucial for emergency care.
Purpose of the Study:
- To characterize the clinical effects of carbamazepine overdose in children.
- To identify serum carbamazepine level thresholds associated with specific toxicities.
- To evaluate the impact of activated charcoal on carbamazepine elimination.
Main Methods:
- A case series combining prospective and retrospective data from pediatric patients with confirmed carbamazepine ingestion.
- Data collected included demographics, physical examination findings, serum carbamazepine levels, ECGs, and treatment details.
- Statistical analysis compared serum levels and outcomes.
Main Results:
- Elevated serum carbamazepine levels (>12 µg/mL) were common (61/77 patients).
- Higher peak serum carbamazepine levels correlated with dystonic reactions, coma, and apnea.
- Seizures were not significantly associated with peak serum levels.
- Multiple doses of activated charcoal shortened carbamazepine half-life compared to single doses.
Conclusions:
- Pediatric patients with carbamazepine levels exceeding 28 µg/mL face increased risk of dystonic reactions, coma, and apnea.
- Seizure risk is not directly correlated with peak carbamazepine levels.
- Aggressive treatment with multiple doses of activated charcoal can accelerate the elimination of carbamazepine.
Study Objective:
To describe the clinical effects of carbamazepine ingestion in a pediatric population.
Design:
Case series of prospectively evaluated patients and a historical retrospective group.
Participants:
All patients younger than 18 years who presented to an urban emergency department with history of carbamazepine ingestion and positive laboratory confirmation.
Interventions:
Patient demographics, findings on physical examination, serum carbamazepine levels, analysis of 12-lead ECGs, and time and doses of activated charcoal were recorded.
Results:
Seventy-seven patients were enrolled, of whom 17 were evaluated prospectively. Serum carbamazepine levels were greater than 12 micrograms/mL (50 mumol/L) in 61 patients. In those 61 patients, mean peak serum level was significantly higher in patients with dystonic reactions (P = .009), coma (P = .002), and apnea (P = .008) than in patients without these symptoms. There was no significant difference in mean peak serum levels between patients with and without seizures. Serum carbamazepine half-life was significantly shorter (P = .022) in patients who received multiple doses of activated charcoal (8.2 +/- 1.6 hours) than in those who received a single dose (12.1 +/- hours).
Conclusion:
Pediatric patients with suspected carbamazepine ingestion are at higher risk for dystonic reactions, coma, and apnea if the peak serum carbamazepine level exceeds 28 micrograms/mL (117 mumol/L). The development of seizures is not related to peak serum level. Multiple doses of activated charcoal can significantly shorten serum carbamazepine half-life.