Hazra Darpanarayan, Ellouze Nejah F, Abri Suad A
Department of Emergency Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman.
Indian J Crit Care Med. 2024 Sep;28(9):866-870. doi: 10.5005/jp-journals-10071-24795. Epub 2024 Aug 31.
Carbamazepine (CBX) is widely used for various medical conditions, but its associated toxicity poses significant clinical concerns. This study aims to provide insights into the clinical presentations, management strategies, and outcomes of CBX toxicity cases in an emergency department (ED) setting.
This was a 10-year retrospective cohort chart review study, including all patients with elevated CBX levels. Data on clinical features, CBX levels, laboratory findings, electrocardiograms (ECGs), patient management, and outcomes were analyzed. Cases were categorized as acute or chronic toxicity.
Out of the 1,965 medical charts reviewed, we included 70 patients with CBX levels above the therapeutic range (prevalence: 3.6%). Chronic CBX toxicity cases (55.7%) were predominant, with gastrointestinal (GI) symptoms being the most common. Most patients presented with isolated CBX overdoses (88.6%), while mixed overdoses (11.4%) were less frequent. Patients were categorized based on CBX levels: 44 had mild toxicity (>51 μmol/L), and 26 had moderate toxicity (>85 μmol/L). Within the mild group, 15 patients experienced acute toxicity, compared to 16 patients in the moderate group. Four patients who had mixed overdoses and low sensorium required intubation and mechanical ventilation. Three patients received activated charcoal (AC), and another 3 patients received multiple doses of AC to reduce drug absorption. The majority of patients (65.7%) required hospital admission, underscoring the seriousness of CBX toxicity. There were no fatalities among these 70 patients.
This study emphasizes the importance of a systematic approach to assessing and managing CBX toxicity, considering its diverse clinical presentations and variations in serum CBX levels.
Hazra D, Ellouze NF, Abri SA. Prevalence and Outcomes of Carbamazepine Toxicity in the Emergency Department: A Single-center Retrospective Study. Indian J Crit Care Med 2024;28(9):866-870.
卡马西平（CBX）广泛用于各种医疗状况，但与其相关的毒性引发了重大临床关注。本研究旨在深入了解急诊科（ED）环境中卡马西平中毒病例的临床表现、管理策略及结局。
这是一项为期10年的回顾性队列图表审查研究，纳入所有卡马西平水平升高的患者。分析了临床特征、卡马西平水平、实验室检查结果、心电图（ECG）、患者管理及结局等数据。病例分为急性或慢性毒性。
在审查的1965份病历中，我们纳入了70例卡马西平水平高于治疗范围的患者（患病率：3.6%）。慢性卡马西平中毒病例占主导（55.7%），胃肠道（GI）症状最为常见。大多数患者表现为单纯卡马西平过量（88.6%），而混合过量（11.4%）较少见。根据卡马西平水平对患者进行分类：44例为轻度中毒（>51 μmol/L），26例为中度中毒（>85 μmol/L）。在轻度组中，15例患者为急性中毒，中度组为16例。4例混合过量且意识水平低的患者需要插管和机械通气。3例患者接受了活性炭（AC）治疗，另外3例患者接受了多剂量AC以减少药物吸收。大多数患者（65.7%）需要住院，这突出了卡马西平毒性的严重性。这70例患者中无死亡病例。
本研究强调了系统评估和管理卡马西平毒性的重要性，需考虑其多样的临床表现及血清卡马西平水平的变化。
Hazra D, Ellouze NF, Abri SA. 急诊科卡马西平中毒的患病率及结局：一项单中心回顾性研究。《印度重症医学杂志》2024；28(9):866 - 870。
