Carbamazepine overdose

 Q: Which of the following drug has no role in the management of Carbamazepine acute toxicity?

A) sodium bicarbonate 

B) diazepam 

C) propofol 

D) phenytoin 

 E) activated charcoal

Answer: D

The major concern in Carbamazepine overdose is QRS interval prolongation leading to fatal arrhythmias. The treatment is sodium bicarbonate to keep QRS interval below 110 milliseconds (choice A).

Seizure secondary to carbamazepine is best treated with benzodiazepines and if frequent boluses of benzodiazepines are required, the patient should be intubated and started on continuous infusion of propofol (Choices B and C).

Phenytoin has no role in Carbamazepine-induced seizure (choice D).

Like any other acute pharmacological toxic ingestion activated charcoal should be utilized for gastrointestinal decontamination (choice E).

#toxicology

References:

1. Spiller HA, Krenzelok EP, Cookson E. Carbamazepine overdose: a prospective study of serum levels and toxicity. J Toxicol Clin Toxicol. 1990;28(4):445-58. doi: 10.3109/15563659009038587. PMID: 2269999. 

2. Al Khalili Y, Sekhon S, Jain S. Carbamazepine Toxicity. 2021 Feb 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29939629.