Background and aims Carbamazepine (CBZ) is a drug structurally similar to tricyclic antidepressants, primarily used in the treatment of epilepsy, but also for other neuropsychiatric disorders. The major mechanism of action is voltage-gated sodium channels. In addition, in toxic doses CBZ exerts anticholinergic effects and antagonises the adenosine receptors, which explains the proconvulsant activity seen with acute poisoning. In this study the authors have planned to analyse a group of paediatric patients (age 0–18 years) admitted in the hospital for acute poisoning with CBZ.
Methods We collected data prospectively in 4 antitoxic reference centres – Bucharest, Iasi, Timisoara and Cluj-Napoca, for a period of 11 months (February 2016-January 2017), in order to describe the demographic, circumstantial, clinical and paraclinical features in acute poisoning with CBZ. 26 cases of acute poisoning corresponded to inclusion criteria. Cases of mixed poisoning with CBZ and other drugs and/or ethanol were excluded.
Results We noticed a peak of incidence in the age group 11–18 years (77%), all these cases being intentional exposures. There was a higher frequency of females (69%) and an equal distribution between the rural and urban environment. We applied in all cases the Poisoning Severity Score. According to this scale the severity was mild in 5 cases, moderate in 14 cases and severe in 7 cases. The main clinical features found in the study were: vomiting (20 cases), coma (16 cases), seizures (7 cases), tachycardia (11 cases) and arterial hypotension (6 cases). The electrocardiographic record displayed persistent bradycardia in 3 cases, intraventricular conduction disturbances in 4 cases and QT interval prolongation in 3 cases. Blood tests showed metabolic acidosis in 10 cases, rhabdomyolysis in 5 cases, and mild elevation in serum hepatic enzymes in 3 cases. Decontamination by gastric lavage was possible in 17 cases, while sodium bicarbonate was used as antidote in 15 cases. The mean duration of hospitalisation was 4.23 days (2–15 days). 15 cases were admitted in ICU in the first 24–48 hours of hospitalisation. Only 4 cases required ventilatory support less than 12 hours.
Conclusions Carbamazepine poisoning may cause various gastrointestinal, cardiovascular and neurological effects in children. Although in our study no fatality was reported, a significant number of patients required intensive care medicine and prolonged hospitalisation.
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