Carbamazepine Toxicity in Emergency Medicine Medication
- Author: Nidhi Kapoor, MD; Chief Editor: Asim Tarabar, MD more...
Medication Summary
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Antidote, Adsorbent
Class Summary
These agents are used to adsorb drugs or poisons after acute ingestion and to limit absorption into systemic circulation. Charcoal is not beneficial for other routes of exposure (eg, IV, inhalation, injection). Clinician should be aware of potential risk of charcoal aspiration and death due to aspiration pneumonia, especially in patients with altered mental status and/or those having seizures. Prudent airway control is recommended in such populations.
Activated charcoal
Network of pores present in activated charcoal adsorbs 100-1000 mg of drug per gram of charcoal. Does not dissolve in water.
For maximum effect, administer within 30 min of ingestion of poison. May administer as aqueous suspension or combine with cathartic (usually sorbitol 70%) in the presence of active bowel sounds.
Repeat dose, if necessary (without cathartic), to adsorb large pill masses or drug packages.
With superactivated forms, use of doses of 0.5 g/kg PO may be possible.
Benzodiazepines
Class Summary
These agents are important for sedation and may act in the spinal cord to induce muscle relaxation. These actions may help counteract the CNS effects caused by carbamazepine toxicity.
Lorazepam (Ativan)
DOC for treatment of status epilepticus because persists in the CNS longer than diazepam. Rate of injection should not exceed 2 mg/min. May be administered IM if unable to obtain vascular access.
Monitoring patient's blood pressure after administering dose is important. Adjust prn.
Diazepam (Valium, Diastat, Diazepam Intensol)
Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA. Third-line agent for agitation or seizures because of shorter duration of anticonvulsive effects and accumulation of active metabolites that may prolong sedation.
Midazolam
Used as alternative in termination of refractory status epilepticus. Because water soluble, takes approximately 3 times longer than diazepam to peak EEG effects. Thus, clinician must wait 2-3 min to fully evaluate sedative effects before initiating procedure or repeating dose. Has twice the affinity for benzodiazepine receptors than diazepam. May be administered IM if unable to obtain vascular access.
Alkalinizing Agent
Class Summary
Indicated for widened QRS resulting from acidosis.
Sodium bicarbonate
Used to correct arrhythmias if patient is diagnosed with bicarbonate-responsive acidosis, hyperkalemia, or overdose resulting in an acidotic state. Routine use for arrhythmia is not recommended.
Cathartic
Class Summary
If extended-release carbamazepine has been ingested, consider using whole-bowel irrigation with a PEG-electrolyte solution.
Polyethylene glycol-electrolyte solution (Colyte, GoLytely, MoviPrep, NuLytely)
Laxative with strong electrolyte and osmotic effects that has cathartic actions in GI tract.
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