Pediatric Carbamazepine Toxicity Follow-up: Further Outpatient Care, Further Inpatient Care, Deterrence/Prevention

Further Outpatient Care

See the list below:

• Patients should follow up with their primary care provider within 24-48 hours after their discharge.
• The physician should reevaluate the patient's condition and discuss the prevention of future episodes.

Further Inpatient Care

Discharge patients with carbamazepine toxicity if the following conditions are met:

• The patient is symptom free and the carbamazepine level has decreased to less than 4-8 mg/L. Obviously, patients with significant toxicity should be admitted and patients with life threatening or potentially life-threatening signs and/or symptoms should be admitted to an ICU.
• An exception to decreasing the carbamazepine level to a subtherapeutic level is in the patient who is taking carbamazepine for seizure control. This patient may be discharged with a therapeutic serum level of carbamazepine or another substituted anticonvulsant.
• After being “medically cleared," the patient should not be discharged from the hospital until personnel from social services or child protective services or a psychiatrist agrees, if the case required the notification of these professionals.

Deterrence/Prevention

See the list below:

• A discussion with the patient's parents concerning the safe storage and dosage of medications is essential.
• Parents should be provided the toll-free telephone number for the American Association of Poison Control Centers (800-222-1222).

Patient Education

See the list below:

• A discussion regarding the prevention of unintentional ingestion is an important component of the routine care of the child.
• The patient's parents should be taught how to safely store medications.
• For patient education resources, see the Drug Overdose Center and Poisoning - First Aid and Emergency Center, as well as Poisoning, Drug Overdose, Activated Charcoal, and Poison Proofing Your Home.

Muhammad Waseem, MD, MS Associate Professor of Emergency Medicine in Clinical Pediatrics, Associate Professor of Clinical Healthcare Policy and Research, Weill Medical College of Cornell University; Consulting Staff, Department of Emergency Medicine, Lincoln Medical and Mental Health Center

Muhammad Waseem, MD, MS is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, Society of Critical Care Medicine, Society for Simulation in Healthcare, American Medical Association

Coauthor(s)

Joel R Gernsheimer, MD, FACEP Visiting Associate Professor, Department of Emergency Medicine, Attending Physician and Director of Geriatric Emergency Medicine, State University of New York Downstate Medical Center

Joel R Gernsheimer, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Geriatrics Society

Nicholas D Caputo, MD House Staff, Department of Emergency Medicine, Lincoln Medical and Mental Health Center/Weill Cornell Medical College

Nicholas D Caputo, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents' Association

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Received salary from Merck for employment.

Chief Editor

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, Wisconsin Medical Society

William T Zempsky, MD Associate Director, Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center

William T Zempsky, MD is a member of the following medical societies: American Academy of Pediatrics

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Girish G Deshpande, MD, to the original writing and development of this article.

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Chemical structure of carbamazepine.