Pediatric carbamazepine suspension overdose - Clinical manifestations and toxicokinetics

Two toddlers ingested unknown quantities of their older sibling's carbamazepine suspension and rapidly manifested central nervous depression requiring intubation in 1 patient. Coma was the primary clinical finding throughout their care with no anticholinergic syndrome, seizures, or dysrhythmia. Both patients recovered without sequelae within 24 hours. Initial carbamazepine concentrations were 36.6 and 22.7 mg/L. The elimination rates (zero-order kinetic) were approximately 1.4 and 0.75 mg/L per hour. We provide the first toxicokinetic data for carbamazepine suspension overdose in children. We confirm that the oral absorption of suspension carbamazepine is rapid necessitating prompt referral to a health care facility for this exposure.