title: Markedly Elevated Carbamazepine-10,11-epoxide/Carbamazepine Ratio in a Fatal Carbamazepine Ingestion.
abstract: Carbamazepine is a widely used anticonvulsant. Its metabolite, carbamazepine-10,11-epoxide, has been found to display similar anticonvulsant and neurotoxic properties. While the ratio of parent to metabolite concentration varies significantly, at therapeutic doses the epoxide concentration is generally about 20% of the parent. We report a case of fatal carbamazepine overdose in which the epoxide metabolite concentration was found to be 450% higher than the parent compound, suggesting a potential role for metabolite quantification in severe toxicity.
authors.affiliation: The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA ; Nationwide Children's Hospital, Columbus, OH 43205, USA.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Russell
authors.affiliation: Nationwide Children's Hospital, Columbus, OH 43205, USA ; Central Ohio Poison Center, Columbus, OH 43205, USA.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Spiller
authors.affiliation: Franklin County Coroner's Office, Columbus, OH 43201, USA.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Baker