ABSTRACT
Se presenta el caso de una menor, previamente sana, que ingirió accidentalmente una dosis de 800mg. de carbamazepina. La paciente ingresa letárgica, en Glasgow 8, requiriendo intubación y manejo en Unidad de Cuidados Intensivos Pediátricos; se practicó lavado gástrico y se administró carbón activado. Durante su hospitalización presentó 4 episodios convulsivos. Los niveles de carbamazepina medidos cerca de 12 horas luego de la ingesta fueron de 19,3 ugr/ml. La eliminación del fármaco en esta paciente (siguiendo una cinética de orden 0) fue de 0,67 ugr/ml/hora. Convulsiones paradojales (por ser provocadas por un anticonvulsivante) han sido descritas infrecuentemente en la infancia como complicación de la intoxicación por carbamazepina; en esta paciente se observaron con niveles plasmáticos menores a aquellos informados habitualmente en la literatura. La paciente evolucionó favorablemente, con recuperación progresiva de conciencia y ataxia, la cual persistió por algunos días.
We report the case of a previously healthy child who accidentally ingested 800 mgs of carbamazepine. On arrival, the patient was lethargic (Glasgow 8), requiring intubation; she was admitted to the ICU and treated with gastric lavage and activated charcoal; during the course of her hospitalization she presented 4 convulsive episodes. The plasma level of carbamazepine, measured approximately 12 hours after ingestion, was 19,3 ugr/ml. The elimination rate (zero-order kinetic) was approximately 0.67 mg/L per hour. Paradoxical seizures have been described infrequently in childhood as a complication of carmazepine overdose; in this patient, they appeared with lower plasma levels than the usually reported in the literature. The patient evolved favorably, with progressive recuperation of conscience and persistent ataxia for a few days.
Subject(s)
Humans , Female , Child, Preschool , Carbamazepine/poisoning , Poisoning/diagnosis , Charcoal/therapeutic use , Poisoning/therapy , Gastric LavageABSTRACT
The aim of the study was to evaluate continous administration of multiple-dose activated charcoal (MDAC) in enhancing elimination of carbamazepine (CBZ) in eight consecutive adolescent suicide attempters. Diluted charcoal was administered through a nasogastric tube at a dose of 1 g/kg every 4 h, and a saline cathartic at the same dosage was administered every 12 h. Plasma CBZ concentrations were neasured at 0.0, 12, 24 and 36 h by means of a modified EMIT technique. A a measure of CBZ disappearance, half life of elimination (tv/2ß) and exogenous total body clearance (CLB) were calculated. Clinical improvement occurred after 12 to 24 h, except in one patient who was the most severely intoxicated and who required advanced life-support therapy. Pharmacokinetic data reported a meat tv/2ß of 9.5 h, shorter than the reference value of 18 - 54 h (p< 0.05), and a mean Cl B of 103.13 ml/min/kg, higher than the reference of 75.01 ml/min/kg (p<0.05). Initial nean CBZ levels of 27.9 decreased to 0.82 µg/ml (97 percent of elimination, p < 0.05). MDAC was free from adverse side effects. In conclusion, MDAC is an effective procedure in enhancing CBZ elimination in overdosed patients as well as being relatively free from serious side effects, widely available, enexpensive and non-invasive
Subject(s)
Adolescent , Humans , Female , Carbamazepine/poisoning , Depression/psychology , Gastric Lavage/methods , Poisoning , Psychology, Adolescent/methods , Psychotherapy , Data Interpretation, Statistical , Suicide, Attempted/statistics & numerical dataABSTRACT
Os autores descrevem um caso de coma causado por intoxicacao acidental com Carbamazepina. Sao analisadas as varias causas de coma em pediatria e a abordagem investigativa e terapeutica adotada. Os autores recomendam a investigacao serica da Carbamazepina em criancas com manifestacao aguda e grave nao esclarecida do sistema nervoso central.