Document Type : Original Article
Authors
- . Ahmad Yaraghi 1
- . Nastaran Eizadi-Mood 2
- . Marzieh Salehi 3
- . Gholamreza Massoumi 1
- . Lejla Zunic 4
- . Ali Mohammad Sabzghabaee 2
1 Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Clinical Toxicology, Noor and Ali Asghar (PBUH) University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
4 Department of Biochemistry, Faculty of Health Sciences, University of Zenica, Zenica, Bosnia and Herzegovina
Abstract
Objective: We aimed to investigate the frequency of seizure after acute carbamazepine
poisoning and the important risk factors related to the outcomes of therapy.
Methods: In this two-year cross‑sectional study conducted in a University Hospital in
Iran, 114 patients with acute carbamazepine poisoning were divided into two groups of
with seizure (n = 8) and without seizure (n = 106) after intoxication. Demographic data,
average amount of drug ingestion, time elapsed from ingestion to hospital admission, history
of seizure before poisoning, mental status, visual disturbances and nystagmus, duration of
hospitalization, the outcomes of therapy, arterial blood gas values and serum biochemical
indices were compared between the two groups.
Findings: Patients with seizure had an estimated (Mean ± SD) ingestion of 14,300 ± 570 mg
carbamazepine, which was significantly higher (P < 0.0001) than the seizure‑free
group (4600 ± 420 mg). The estimated average time between drug ingestion and hospital
admission in patients with seizure and the seizure‑free group were 515 ± 275 and
370 ± 46 minutes, respectively (P < 0.0001). In this study, 104 out of the total number of
patients had recovered without any complication. Need for respiratory support, including
airway support or intubation were the most recorded complication. One patient died after
status epilepticus and aspiration pneumonia.
Conclusion: The ingested amount of carbamazepine and the time elapsed from the
ingestion of drug to hospital admission may influence the occurrence of seizure after acute
carbamazepine poisoning; however, the outcome of supportive care in these patients seems
to be positive.
Keywords
- Dart RC, Bronstein AC, Spyker DA, Cantilena LR, Seifert SA,
Heard SE, et al. Poisoning in the United States: 2012 Emergency
medicine report of the national poison data system. Ann
Emerg Med 2014 [Epub ahead of print].
2. Hassanian-Moghaddam H, Zarei MR, Kargar M, Sarjami S,
Rasouli MR. Factors associated with nonbenzodiazepine
antiepileptic drug intoxication: Analysis of 9,809 registered
cases of drug poisoning. Epilepsia 2010;51:979‑83.
3. Spiller HA, Krenzelok EP, Cookson E. Carbamazepine
overdose: A prospective study of serum levels and toxicity.
J Toxicol Clin Toxicol 1990;28:445‑58. - 4. Sharma P, Gupta RC, Bhardwaja B, Mathur AK. Status
epilepticus and death following acute carbamazepine
poisoning. J Assoc Physicians India 1992;40:561‑2.
5. Weaver DF, Camfield P, Fraser A. Massive carbamazepine
overdose: Clinical and pharmacologic observations in five
episodes. Neurology 1988;38:755‑9.
6. Mise S, Jukic I, TonkicA, Titlic M, Mise S. Multidose activated
charcoal in the treatment of carbamazepine overdose with
seizures: A case report. Arh Hig Rada Toksikol 2005;56:333‑8.
7. Graudins A, Peden G, Dowsett RP. Massive overdose with
controlled-release carbamazepine resulting in delayed peak
serum concentrations and life-threatening toxicity. Emerg
Med (Fremantle) 2002;14:89‑94.
8. YildizTS, ToprakDG, ArisoyES, SolakM, Toker K. Continuous
venovenous hemodiafiltration to treat controlled-release
carbamazepine overdose in a pediatric patient. Paediatr
Anaesth 2006;16:1176-8.
9. MackRB. Julius seizure – Carbamazepine (Tegretol) poisoning.
N C Med J 1985;46:41‑2.
10. Brandstetter F, Fleischhacker G, Kölbl F. Carbamazepine
poisoning in a small child. Padiatr Padol 1982;17:741-6.
11. Theodore WH, Narang PK, Holmes MD, Reeves P, Nice FJ.
Carbamazepine and its epoxide: Relation of plasma levels to
toxicity and seizure control. Ann Neurol 1989;25:194‑6.
12. Liu L, Zheng T, Morris MJ, Wallengren C, ClarkeAL, Reid CA,
et al. The mechanism of carbamazepine aggravation of absence
seizures. J Pharmacol Exp Ther 2006;319:790-8.
13. Otoom S, Al-Hadidi H. Seizure induced by antiepileptic drugs.
Ann Saudi Med 2000;20:316-8.
14. Perucca E, Gram L, Avanzini G, Dulac O. Antiepileptic drugs
as a cause of worsening seizures. Epilepsia 1998;39:5‑17.
15. Araújo IM, Ambrósio AF, Leal EC, Verdasca MJ, Malva JO,
Soares-da-Silva P, et al. Neurotoxicity induced by antiepileptic
drugs in cultured hippocampal neurons: A comparative study
between carbamazepine, oxcarbazepine, and two new putative
antiepileptic drugs, BIA 2-024 and BIA 2-093. Epilepsia
2004;45:1498‑505.
16. Clemens B, Ménes A, Nagy Z. Objective assessment
of neurotoxicity while shifting from carbamazepine to
oxcarbazepine. Acta Neurol Scand 2004;109:324-9.
17. KuzGM, ManssourianA. Carbamazepine-induced hyponatremia:
Assessment of risk factors. Ann Pharmacother 2005;39:1943‑6.
18. Holtschmidt-Täschner B, Soyka M. Hyponatremia-induced
seizure during carbamazepine treatment. World J Biol
Psychiatry 2007;8:51‑3.
19. SabzghabaeeAM, SoleimaniM, FarajzadeganZ, HosseinpoorS,
Mirhosseini SM, Eizadi-Mood N. Social risk factors and
outcome analysis of poisoning in an Iranian referral medical
center: A toxico-epidemiological approach. J Res Pharm Pract
2013;2:151‑5.
20. Spiller HA, Carlisle RD. Status epilepticus after massive
carbamazepine overdose. J Toxicol Clin Toxicol 2002;40:81-90.
21. Garzon E, Fernandes RM, Sakamoto AC. Analysis of clinical
characteristics and risk factors for mortality in human status
epilepticus. Seizure 2003;12:337‑45.
22. GoldfrankLR, HoffmanRS. Goldfrank’s Manual of Toxicologic
Emergencies. New York: McGraw‑Hill, Medical Pub. Division;
2007.
23. Hassanian-Moghaddam H, Zamani N, Sarjami S. Violence
and abuse against women who have attempted suicide by
deliberate self-poisoning: A 2-year follow-up study in Iran.
J Interpers Violence 2014 [Epub ahead of print].
24. Mokhber N, Lane CJ, Azarpazhooh MR, Salari E, Fayazi R,
Shakeri MT, et al. Anticonvulsant treatments of dysphoric
mania: A trial of gabapentin, lamotrigine and carbamazepine
in Iran. Neuropsychiatr Dis Treat 2008;4:227‑34.
25. Chen ZJ, Wang XD, Zhou LM, Fang ZY, Wang HS, Li JL, et al.
Effects of carbamazepine on plasma concentrations of valproic
acid and its toxic metabolite in epileptic patients. Yao Xue Xue
Bao 2014;49:530‑4
)