Lamotrigine overdose
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Neurological disorders: case report A 17-year-old girl experienced unconsciousness, agitation and confusion after ingesting an overdose of lamotrigine [Lamictal; dosage and time to reaction onset not stated]. The girl, who had a history of depression, post traumatic stress disorder and two serious suicide attempts, was found unconscious in her room with empty boxes of lamotrigine, ibuprofen and paracetamol [acetaminophen]; she had been pale and unwell looking when she was last seen at 1700 hours. She vomited several times. On arrival of a doctor (1905 hours), she was unconscious with uncontrolled limb movement and dilated pupils. She had a Glasgow Coma scale score of 6. She was intubated and transferred to a hospital. Blood tests revealed an O2 saturation of 97%, a pH of 7.43 and a base excess of -1.9. The girl received gastric lavage, activated charcoal, and acetylcysteine, which was discontinued after serum analysis for paracetamol was negative. Subsequently, she became increasingly agitated and she received propofol. She also received IV fluids. She had an ibuprofen concentration of 19.3 µmol/L. Her serum lamotrigine concentration was 161.3 µmol/L (reference range 10–50), which was 138.0 µmol/L 8 hours after admission and 77.0 µmol/L 19 hours after admission. The following morning, she was extubated and transferred to an ICU. She had increasing agitation and received levomepromazine; she also appeared confused. Her agitation persisted and she received propofol until the next day. That evening, she awoke and gave adequate answers to questions. Her haemoglobin level decreased from 8.2 (at admission) to 7.2, which was suspected to be due to fluid administration. She also had low mean corpuscular volume and MCH levels and received iron supplementation. Two days after admission, she was discharged. Reimers A, et al. Acute lamotrigine overdose in an adolescent. Therapeutic Drug 801091819 Monitoring 29: 669-670, No. 5, Oct 2007 - Norway
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Reactions 20 Oct 2007 No. 1174
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