Carbamazepine/charcoal

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Various toxicities: 2 case reports In a report, two patients (a 19-year-old man and a 20-year-old woman) were described. The man developed gait disturbance, dizziness, blurred vision, speech disorders and clouding of consciousness after intoxication of carbamazepine, and thrombocytopenia during treatment with charcoal. The woman developed clouding of consciousness and coma due to carbamazepine intoxication following an overdose in an attempt of suicide [routes not stated; not all dosages and times to reactions onsets stated]. Case 1: The man was admitted to the emergency department of Bakirkoy Dr. Sadi Konuk teaching hospital, Istanbul, Turkey due to gait disturbance, blurred vision, speech disorders and dizziness one week following the initiation of carbamazepine on 11 December 2017. He had been receiving carbamazepine along with risperidone and escitalopram for anxiety disorder. On admission, investigations showed the following: BP 105/60mm Hg, oxygen saturation 98%, pulse rate 125 /min, body temperature 36.80°C and Glasgow Coma Scale 10/15. His pupils were isochoric and bilateral pupillary light reflex was positive. Laboratory investigation showed the following: urea 29 mg/dL, sodium 139 mmol/L, leucocytes 6000 /mm3, haemoglobin 13 gr/dL, platelet 263000 /mm3, creatinine 0.8 mg/dL, potassium 4.25 mmol/L, calcium 9.11 mg/dL. Arterial blood gas analysis showed as follows: pH 7.42, partial pressure of carbon dioxide 43.8mm Hg, partial pressure of arterial oxygen 76.2mm Hg, bicarbonate 27.1 mmol/L, oxyhaemoglobin saturation 96%. Serum carbamazepine level was found to be 56 µg/mL. Then, charcoal [activated charcoal] was applied with a nasogastric cathete. He was administered with sodium chloride [isotonic solution] and glucose [dextrose]. After 6 hours from the admission, he underwent charcoal [Adsorba] haemoperfusion as the carbamazepine level was in toxic range, and he had a clouding of consciousness. Following the one session of charcoal haemoperfusion, his carbamazepine level was 15.6 µg/mL. Eventually, his consciousness recovered after haemoperfusion. He was administration with 50grams of charcoal continued every 4 hours. His platelet count was 128.000 /mm3 (thrombocytopenia). Subsequently, his thrombocytopenia resolved. After 24 hours, he was discharged with a carbamazepine level of 8 µg/mL. Further, his general condition improved. Later, it was considered that the thrombocytopenia was associated with charcoal. Case 2: The 20-year-old woman was admitted to the emergency room of Bakirkoy Dr.Sadi Konuk teaching hospital, Istanbul, Turkey due to clouding of consciousness on 5 February 2015. She took unknown amount of carbamazepine tablets (each carbamazepine tablet was 400mg) in an attempt of suicide. On physical examination, her BP was 130/80mm Hg and pulse rate was 126 /min. She was in coma and her Glasgow Coma Scale was 3/15. Thus, she was intubated in the emergency room. Her pupils were anisocoric. The charcoal [activated charcoal] was applied with a nasogastric catheter. Laboratory investigations showed

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