Management of acute carbamazepine poisoning: A narrative review

Table 2 Executive summary of recommendations for the treatment of carbamazepine poisoning

General statement

The primary treatment for CBZ poisoning is GL

A mainstay of treatment is multiple-dose activated charcoal

ECTR is suggested in cases of severe CBZ poisoning

Intermittent hemodialysis is the preferred ECTR for CBZ poisoning

Lipid resuscitation therapy is an effective adjunctive treatment to ECTR

Supportive care

Severe central nervous system depression requires endotracheal intubation

To avoid masking subsequent seizures, short-acting neuromuscular blockers are recommended

Isotonic crystalloid to correct hypotension should be considered first; when isotonic crystals do not work, direct-acting vasopressors can be applied

QRS prolongation is treated with sodium bicarbonate

Management precautions

GL is contraindicated when patients have impaired consciousness, recent surgery, no protection of airway, risk of gastrointestinal bleeding and perforation, and the potential for increased risk and severity of aspiration

Multiple-dose activated charcoal should be used with caution in cases of an unprotected airway, presence of intestinal obstruction, or gastrointestinal tract not anatomically intact

CBZ: Carbamazepine; ECTR: Extracorporeal treatment; GL: Gastric lavage.