Carbamazepine poisoning in adolescent suicide attempters. Effectiveness of multiple-dose activated charcoal in enhancing carbamazepine elimination.

The aim of the study was to evaluate continuous administration of multiple-dose activated charcoal (MDAC) in enhancing elimination of carbamazepine (CBZ) in eight consecutive adolescent suicide attempters. Diluted charcoal was administered through a nasogastric tube at a dose of 1 g/kg every 4 h, and a saline cathartic at the same dosage was administered every 12 h. Plasma CBZ concentrations were measured at 0.0, 12, 24 and 36 h by means of a modified EMIT technique. As a measure of CBZ disappearance, half life of elimination (t1/2 beta) and exogenous total body clearance (CLB) were calculated. Clinical improvement occurred after 12 to 24 h, except in one patient who was the most severely intoxicated and who required advanced life-support therapy. Pharmacokinetic data reported a mean t1/2 beta of 9.5 h, shorter than the reference value of 18-54 h (p < 0.05), and a mean CLB of 103.13 ml/ min/kg, higher than the reference of 75.01 ml/min/ kg (p < 0.05). Initial mean CBZ levels of 27.9 decreased to 0.82 microgram/ml (97% of elimination, p < 0.05). MDAC was free from adverse side effects. In conclusion, MDAC is an effective procedure in enhancing CBZ elimination in overdosed patients as well as being relatively free from serious side effects, widely available, inexpensive and non-invasive.