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 mult iple-dose activated charcoal (MDAC) in enhancing elimination of carbam azepine (CBZ) in eight consecutive adolescent suicide attempters. Dilu ted 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 admini stered 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 CB Z disappearance, half life of elimination (t 1/2(beta)) and exogenous total body clearance (CL(B)) were calculated. Clinical improvement occ urred after 12 to 24 h, except in one patient who was the most severel y intoxicated and who required advanced life-support therapy. Pharmaco kinetic data reported a mean t 1/2(beta) of 9.5 h, shorter than the re ference value of 18 - 54 h (p < 0.05), and a mean CL(B) of 103.13 ml/m in/kg, higher than the reference of 75.01 ml/min/kg (p < 0.05). Initia l mean CBZ levels of 27.9 decreased to 0.82 mu g/ml (97% of eliminatio n, p < 0.05). MDAC was free from adverse side effects; In conclusion, MDAC is an effective procedure in enhancing CBZ elimination in overdos ed patients as well as being relatively free from serious side effects , widely available, inexpensive and non-invasive.