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Case Reports in Medicine
Volume 2015, Article ID 369707, 4 pages
Case Report

Markedly Elevated Carbamazepine-10,11-epoxide/Carbamazepine Ratio in a Fatal Carbamazepine Ingestion

1The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
2Nationwide Children’s Hospital, Columbus, OH 43205, USA
3Central Ohio Poison Center, Columbus, OH 43205, USA
4Franklin County Coroner’s Office, Columbus, OH 43201, USA

Received 13 July 2015; Revised 14 September 2015; Accepted 16 September 2015

Academic Editor: Bruno Megarbane

Copyright © 2015 Jason L. Russell et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.