Tibballs J
Intensive Care Unit, Royal Children's Hospital, Melbourne, Australia.
J Pediatr. 1992 Aug;121(2):295-9. doi: 10.1016/s0022-3476(05)81208-9.
The clinical spectrum of toxic effects and serum concentrations after ingestion of carbamazepine were studied in 82 pediatric patients. Serum carbamazepine level was related to the depth of coma (p less than 0.001), convulsions (p = 0.002), hypotension (p less than 0.001), and the requirement for mechanical ventilation (p less than 0.001). In 10 patients in deep coma with a Glasgow Coma Scale (GCS) of 3-4, the mean serum level was 213 mumol/L (range 143 to 343); seizures, ventilatory failure, or hypotension caused by myocardial failure and conduction defects were observed. In four of these, large doses of inotropic agents were required, one patient was treated with plasmapheresis, and two died--one of cardiac failure and one of aspiration pneumonitis. In 27 patients with moderate coma (GCS 5-8), the mean serum level of carbamazepine was 112 mumol/L (range 63 to 176); convulsions were observed in two patients in this group. In 45 patients whose conscious state was mildly depressed or normal (GCS 9-15), the mean serum level was 73 mumol/L (range 37 to 128); additional effects were drowsiness (80%), ataxia (53%), nystagmus (38%), vomiting (17%), and dystonia (7%). I conclude that patients with serum carbamazepine levels of approximately 100 mumol/L require close observation, whereas those with levels greater than 150 mumol/L may require intensive life support.
对82例儿科患者摄入卡马西平后的中毒效应临床谱及血清浓度进行了研究。血清卡马西平水平与昏迷深度（p<0.001）、惊厥（p=0.002）、低血压（p<0.001）及机械通气需求（p<0.001）相关。10例格拉斯哥昏迷量表（GCS）评分为3 - 4分的深昏迷患者，血清平均水平为213μmol/L（范围143至343）；观察到由心肌衰竭和传导缺陷引起的惊厥、呼吸衰竭或低血压。其中4例需要大剂量的强心剂，1例接受了血浆置换治疗，2例死亡——1例死于心力衰竭，1例死于吸入性肺炎。27例中度昏迷（GCS 5 - 8分）患者，卡马西平血清平均水平为112μmol/L（范围63至176）；该组中有2例患者出现惊厥。45例意识状态轻度抑郁或正常（GCS 9 - 15分）的患者，血清平均水平为73μmol/L（范围37至128）；其他影响包括嗜睡（80%）、共济失调（53%）、眼球震颤（38%）、呕吐（17%）和肌张力障碍（7%）。我的结论是，血清卡马西平水平约为100μmol/L的患者需要密切观察，而水平高于150μmol/L的患者可能需要强化生命支持。
