Management of acute carbamazepine poisoning: A narrative review

Table 1 Clinical outcomes of the 67 patients described in the case reports

Patient demographics	Values
Median age (yr)	25 (1.5-85)
Male sex	49.3
Poisoning exposure
Mean peak carbamazepine concentration in mg/L	39.0 (17.7-93.8)
Clinical symptoms and signs
Respiratory depression	47.8
Decreased consciousness	100
Seizure	20.9
Hypotension	14.9
Dysrhythmias	19.4
Treatment measure1
Supportive care	9.0
Gastric lavage	29.9
Multiple-dose activated charcoal	58.2
Hemoperfusion	22.4
Hemodialysis	22.4
Continuous renal replacement treatment	12.0
Plasma exchange and plasmapheresis	4.5
Lipid resuscitation therapy	4.5
Outcome
Recovery	82.0
Sequelae	12.0
Fatalities	6.0

¹Some patients received more than one treatment.

Data are presented as n (range) or %. The source of cases is listed in Supplement Material.

Table 2 Executive summary of recommendations for the treatment of carbamazepine poisoning

General statement

The primary treatment for CBZ poisoning is GL

A mainstay of treatment is multiple-dose activated charcoal

ECTR is suggested in cases of severe CBZ poisoning

Intermittent hemodialysis is the preferred ECTR for CBZ poisoning

Lipid resuscitation therapy is an effective adjunctive treatment to ECTR

Supportive care

Severe central nervous system depression requires endotracheal intubation

To avoid masking subsequent seizures, short-acting neuromuscular blockers are recommended

Isotonic crystalloid to correct hypotension should be considered first; when isotonic crystals do not work, direct-acting vasopressors can be applied

QRS prolongation is treated with sodium bicarbonate

Management precautions

GL is contraindicated when patients have impaired consciousness, recent surgery, no protection of airway, risk of gastrointestinal bleeding and perforation, and the potential for increased risk and severity of aspiration

Multiple-dose activated charcoal should be used with caution in cases of an unprotected airway, presence of intestinal obstruction, or gastrointestinal tract not anatomically intact

CBZ: Carbamazepine; ECTR: Extracorporeal treatment; GL: Gastric lavage.