Treatment of Oxcarbazepine Poisoning

Initial Management and Supportive Care

The American Heart Association recommends establishing and maintaining airway patency with bag-mask ventilation or endotracheal intubation as needed for patients with CNS depression and loss of protective airway reflexes 4, 5
The American Heart Association suggests providing supplemental oxygen and supporting breathing as required, although the strength of evidence is not specified 6
Establishing intravenous access and administering IV fluids for volume resuscitation is recommended, with a strength of evidence not provided 6
Continuous monitoring of vital signs, including cardiac monitoring for dysrhythmias, is advised, with no specific strength of evidence mentioned 6
Contacting poison control (1-800-222-1222 in the US) for expert guidance on specific case management is recommended, with a high strength of evidence 4, 5

For QRS prolongation or wide-complex dysrhythmias, administering sodium bicarbonate 1-2 mEq/kg IV bolus is recommended, with a high strength of evidence 1, 2, 3, 6
For hypotension unresponsive to IV fluids, administering vasopressors such as dopamine or vasopressin is suggested, with a moderate strength of evidence 6
Monitoring ECG closely for intraventricular conduction delay and terminal rightward axis deviation in lead aVR is advised, with a high strength of evidence 1, 2, 3

For seizures or severe agitation, administering benzodiazepines (diazepam first-line or midazolam) is recommended, with a high strength of evidence 1, 2, 3, 6

Avoiding neuromuscular blockers metabolized by cholinesterase (succinylcholine, mivacurium) in patients with potential anticholinergic effects is recommended, with a moderate strength of evidence 2, 3, 6
Considering co-ingestions, as mixed overdoses are common and may complicate management, is advised, with a high strength of evidence 4, 5