Carbamazepine toxicity: Difference between revisions
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==Management== | ==Management== | ||
*GI | *GI decontamination | ||
**[[Activated Charcoal]] (if presents within 1hr of ingestion) | **[[Activated Charcoal]] (if presents within 1hr of ingestion) | ||
*[[Dialyzable Drugs|Dialysis]] | *[[Dialyzable Drugs|Dialysis]] for severe cases. Indications: <ref>Ghannoum M, Yates C, Galvao TF et al. Extracorporeal treatment for carbamazepine poisoning: Systematic review and recommendations from the EXTRIP workgroup. Clin Tox 2016. 52(10):993-1004.</ref> | ||
**Intractable seizures or life threatening dysrhythmia (level 1D recommendation ) | |||
**Respiratory depression requiring mechanical ventilation or prolonged coma (level 2D suggestion) | |||
**Significant toxicity or rising/persistent carbamazepine level despite [[activated charcoal]] and supportive care (level 2D suggestion) | |||
==Disposition== | ==Disposition== | ||
Revision as of 17:55, 11 August 2016
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 decontamination
- Activated Charcoal (if presents within 1hr of ingestion)
- Dialysis for severe cases. Indications: [1]
- Intractable seizures or life threatening dysrhythmia (level 1D recommendation )
- Respiratory depression requiring mechanical ventilation or prolonged coma (level 2D suggestion)
- Significant toxicity or rising/persistent carbamazepine level despite activated charcoal and supportive care (level 2D suggestion)
Disposition
- Consider discharge for patient with decreasing levels (measured few hrs apart) and is asymptomatic
References
- ↑ Ghannoum M, Yates C, Galvao TF et al. Extracorporeal treatment for carbamazepine poisoning: Systematic review and recommendations from the EXTRIP workgroup. Clin Tox 2016. 52(10):993-1004.