Observation and patient disposition after carbamazepine and oxcarbazepine poisonings

Admit any patient who has ingested more than 50 mg/kg of carbamazepine for at least 12 hours of observation and ECG monitoring. This may involve admission to an intensive care unit. Measure at least two serum carbamazepine concentrations during this time.

Discharge patients if they remain asymptomatic for at least 6 hours after poisonings of:

• less than 50 mg/kg of carbamazepine
• any dose of oxcarbazepine.

Medical observation is also recommended for drug-naive children who have accidentally ingested more than 20 mg/kg of carbamazepine, or more than 30 mg/kg of oxcarbazepine. Drug-naive children who have accidentally ingested less than these doses can be discharged if they are asymptomatic and can be supervised in a safe environment.

Sedative drugs can continue to cause significant cognitive impairment for several days following exposure. Advise patients not to drive or operate machinery for at least 3 days after discharge.