Both carbamazepine and phenobarbital are known to have antidiuretic properties when administered chronically. We describe a case of acute impairment of body water homeostasis following mixed drug overdose with carbamazepine and phenobarbital. Serum carbamazepine concentrations correlated with alternating states of diuresis and antidiuresis. We recommend close monitoring of fluid and electrolyte status in carbamazepine overdose.
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References
1.
GrahamJCZilkaKJ. Treatment of trigeminal neuralgia with carbamazepine. Br Med J1966; 1: 210–1.
2.
TroupinASGreenJRLevyRH. Carbamazepine as an anticonvulsant: A pilot study. Neurology1974; 24: 863–9.
3.
CrillWE. Carbamazepine. Ann Intern Med1973; 79: 844–7.
4.
BraunhoferJZichaL. Eroffnet Tegretal neue therapiemoglichkeiten bei bestimmten neurologischen und endokrinen Krankheitsbilclern. Med Welt1966; 36: 1875–80.
5.
WalesJK. Treatment of diabetes insipidus with carbamazepine. Lancet1975; 2: 948–51.
6.
MeindersAECejkaVRobertsonGL. The antidiuretic action of carbamazepine in man. Clin Sci Mol Med1974; 47: 289–99.
7.
BodoBCPrescottKF. The antidiuretic action of barbiturates (phenobarbital, amytal, pentobarbital) and the mechanism involved in this action). J Pharmacol Exp Ther1945; 85: 222–33.
8.
KalffRHoutkooperAMeterJW. Carbamazepine and serum sodium level. Epilepsia1984; 25: 390–7.
9.
RadoJP. Water intoxication during carbamazepine treatment. Br Med J1973; 3: 479.
10.
StephensWPEspirMLETattersallBB. Water intoxication due to carbamazepine. Br Med J1977; 1: 754–5.
11.
FlegalKMColeCH. Inappropriate antidiuresis during carbamazepine treatment. Ann Intern Med1977; 87: 722–3.
12.
SmithNJEspirMLE. Raised plasma arginine-vasopressin concentration in carbamazepine-induced water intoxication. Br Med J1977; 2: 804.
13.
AshtonMGBallSGThomasTH. Water intoxication associated with carbamazepine treatment. Br Med J1977; 1: 1134–5.
14.
PeruccaEGarrattAHebdigeS. Water intoxication in epileptic patients receiving carbamazepine. J Neurol Neurosurg Psychiatry1978; 42: 713–8.
15.
LahrMB. Hyponatremia during carbamazepine therapy. Clin Pharmacol Ther1985; 37: 693–6.
16.
HenryDAReaveyPRenfrewS. Hyponatremia during carbamazepine treatment. Br Med J1977; 1: 83–4.
MyDC. Acute carbamazepine intoxication: Clinical spectrum and management. South Med J1984; 77: 24–6.
19.
DenningDWMathesonLBrysonSM. Death due to carbamazepine self poisoning: Remedies reviewed. Hum Toxicol1985; 4: 255–60.
20.
De-ZeeuwRAWestenteryGMVan Der KleijneE. An unusual case of carbamazepine poisoning with near fatal relapse after two days (letter). Clin Toxicol1979; 14: 263.
21.
UhuchFLoeschkeKEiglerJ. Antidiuretic effect of carbamazepine in central diabetes insipidus (abstract). Acta EndocrinolSuppl (Copenh) 1972; 159: 51.
22.
KimuraTMatsuiKTatsuoS. Mechanism of carbamazepine (Tegretol)-induced antidiuresis: Evidence for release of antidiuretic hormone and impaired excretion of water load. J Clin Endocrinol Metab1974; 38: 356–62.
23.
SoreusenPSHammerM. Effects of long-term carbamazepine treatment on water metabolism and plasma vasopressin concentration. Eur J Clin Pharmacol1984; 26: 719–22.
24.
StephensWPCoeJYBaylisPH. Plasma arginine-vasopressin concentrations and antidiuretic action of carbamazepine. Br Med J1978; 1: 1445–7.
25.
NeuvonenPJElohenE. Effect of activated charcoal on absorption and elimination of phenobarbitone, carbamazepine and phenylbutazone in man. Eur J Clin Pharmacol1980; 17: 51–7.
26.
GaryNEByraWMEisingerRP. Carbamazepine poisoning: Treatment by hemoperfusion. Nephron1981; 27: 202–3.
27.
EichelbaumMEkbomKBertilssonL. Plasma kinetics of carbamazepine and its epoxide metabolite in man after single and multiple doses. Eur J Clin Pharmacol1975; 8: 337–41.
