Carbamazepine/quetiapine overdose
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Intestinal obstruction, treated with neostigmine: case report A 22-year-old man developed an intestinal obstruction after an overdose of carbamazepine and quetiapine. The man, who had a history of bipolar disorder, was found unresponsive with empty bottles of carbamazepine and quetiapine nearby [amounts of overdoses, routes and time to reaction onset not stated]. On arrival at an emergency department, he had dry mucosal membranes and decreased consciousness, with agitation on physical stimulation. Tests revealed a serum carbamazepine concentration of 18.9 mg/L (therapeutic range 4–10 mg/L). The man was intubated and received charcoal for 24 hours. He experienced intermittent tonic-clonic seizures and his carbamazepine concentration increased to 46.5 mg/L. On hospital day 2, charcoal was withdrawn, and he received polyethylene glycol. However, by day 3, he had abdominal distention, with no bowel sounds or movement. X-ray showed an intestinal obstruction. He then received IV neostigmine 2mg. Within 10 minutes, he experienced a bowel movement. His carbamazepine concentration subsequently decreased and his condition improved over the next 48 hours. Author comment: "Given the toxicodynamics of quetiapine and [carbamazepine], antimuscarinic receptor activity was likely the etiology for the ileus." Kowalski JM, et al. Resolution of Anticholinergic Induced Ileus after Neostigmine Administration. 2011 North American Congress of Clinical Toxicology : abstr. 54, 803062987 21 Sep 2011. - USA
0114-9954/10/1378-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 19 Nov 2011 No. 1378
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