Carbamazepine overdose presenting as a diabetes insipidus –like condition in a child

overdoses it can produce various side effects involving neurological, cardiac, hematological and endocrinal systems. Inappropriate secretion of Anti Diuretic Hormone (ADH) is a well-known complication of carbamazepine toxicity. We are reporting an unusual complication in an adolescent girl with intentional carbamazepine overdose. A sixteen year old female with carbamazepine ingestion presented to our hospital with altered sensorium. On admission she was found to have a very high serum carbamazepine level and metabolic acidosis. In contrast to the possible inappropriate secretion of ADH, as an adverse effect of carbamazepine, her hospital course was complicated with a diabetes insipidus – like condition following treatment with multiple doses of activated charcoal and sodium bicarbonate therapy.

Carbamazepine, Diabetes Insipidus, activated charcoal, child

1. Moury JB, Spyker DA, Cantilena LR Jr, Bailey JE, Ford M. 2012 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 30th Annual Report. Clin Toxicology 2013;51:949–1229.

2. Brunton LL, JS Lazo, Parker KL. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 11th Edition., New York: McGraw-Hill; 2012. p. 511-3.

3. Stremski ES, Brady WB, Prasad K, Hennes HA. Pediatric carbamazepine intoxication. Ann Emerg Med 1995;25:624.

4. Starmer CF, Lastra AA, Nesterenko VV, Grant AO. Proarrhythmic response to sodium channel blockade. Theoretical model and numerical experiments. Circulation 1991; 84:1364.

5. Soderstrom J, Murray L, Little M, Daly F FS. Toxicology case of the month: carbamazepine overdose. Emerg Med J 2006;23:869-71.

6. Amelsvoort Van Th, Bakshi R, Devaux CB, Schwabe S. Hyponatremia Associated with Carbamazepine and Oxcarbazepine Therapy: A Review. Epilepsia 1994;35(1):181-8.

7. Aggarwal A, Rastogi N, Mittal H, Chillar N, Patil R. Thyroid hormone levels in children receiving carbamazepine or valproate. Pediatr Neurol Sep 2011;45(3):159-62.

8. Ellison DH, Berl T. Clinical practice. The syndrome of inappropriate antidiuresis. N Engl J Med 2007;356:2064-72.

9. Smith NJ, Espir ML, Baylis PH. Raised plasma arginine vasopressin concentration in carbamazepine-induced water intoxication. Br Med J 1977;2:804.

10. Bragança AC, Moyses ZP, Magaldi AJ. Carbamazepine can induce kidney water absorption by increasing aquaporin 2 expression. Nephrol Dial Transplant 2010;25(12):3840-5.

11. Wales JK. Treatment of diabetes insipidus with carbamazepine. Lancet 1975;2:948.

12. Wason S, Baker RC, Carolan P, Seigel R, Druckenbrod RW. Carbamazepine overdose – the effects of multiple dose activated charcoal. Clin Toxicol 1992;30:39-48.