Abstract
Certain drugs may produce hyperglycemia by decreasing pancreatic secretion of insulin. We report a case of accidental carbamazepine overdose in a previously healthy three year old black male who presented in an unconscious state without seizures with an arterial pH of 7.28, serum glucose of 210 mg/dl, and urine glucose and ketones of 3+ and 2+, respectively. Arterial blood gases showed a pure metabolic acidosis. A diagnosis of diabetic ketoacidosis was made; the patient was given insulin, sodium bicarbonate, and intravenous hydration. Subsequent history revealed that the patient ingested an unknown amount of carbamazepine. A toxic serum carbamazepine level of 22 mcg/ml (therapeutic = 6 to 10) was found. The patient was treated with activated charcoal and general supportive care. Complete symptomatic recovery occurred by the end of 48 hours and follow up laboratory studies failed to show any evidence of hyperglycemia, ketonuria, or glycosuria.
This case demonstrates a previously unreported manifestation of carbamazepine overdose in a child, i.e., metabolic acidosis, hyperglycemia and ketonuria. Carbamazepine in high dose is known to produce hyperglycemia in rats possibly by decreasing the sodium influx needed for insulin secretion (Pharmacology 24:123, 1982). We conclude that metabolic acidosis due to carbamazepine overdose should be considered in the differential diagnosis of altered metabolic states and drug overdose.
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Hughes, H., Mamlok, R., Dodge, W. et al. 189 METABOLIC ACIDOSIS, HYPERGLYCEMIA, AND KETONURIA IN CARBAMAZEPINE OVERDOSE. Pediatr Res 19, 142 (1985). https://doi.org/10.1203/00006450-198504000-00219
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DOI: https://doi.org/10.1203/00006450-198504000-00219