Ataxic Girl

Ataxic Girl Cont'

Thank you all for excellent comments Acute carbamazepine toxicity is characterized by neurologic and cardio­vascular effects. The neurologic disturbances include nystagmus, ataxia, seizures, and coma. Cardiovascular effects include sinus tachycardia, hypotension, myocardial depression, and, rarely, cardiac conduction abnormalities such as QRS complex and QT interval prolongation. The toxicity of carbamazepine in children differs slightly from that in adults. Children experience a higher incidence of dystonic reactions, choreoathetosis, and seizures and have a lower inci­dence of ECG abnormalities. The incidence of carbamazepine-induced hyponatremia ranges from 1.8% to 40%. Increased antidiuretic hormone secretion (SIADH) or increased sensitivity of peripheral osmoreceptors to antidiuretic hormone are sug­gested mechanisms Serum Carbamazepine level can be checked.Carbamazepine cross-reacts with some toxicology screening for tricyclic antidepressants The Mainstay of management is supportive care - Multiple-dose activated charcoal is associated with improved outcomes in several studies and is rec­ommended for to patients presenting with large overdoses, if there are no contraindications. - Seizures should be treated with benzodiazepines. - Vasopressors should be used for hypotension that is refractory to fluids. - Sodium bicarbonate is recommended if the QRS complex duration exceeds 100 milliseconds (ms). Serial serum concentrations should be obtained owing to delays in peak concentrations. -Extracorporeal drug removal is reasonable in cases of severe poisonings associated with intractable sei­zures or life-threatening dysrhythmias.Intermittent hemodialysis (HD) is preferred References 1. Goldrank’s Toxicologic Emergencies 11th edition