Acute Carbamazepine Intoxication
Round 1
Reviewer 1 Report
The authors describe the feaures of carbamazepine overdose. In Western countries the use of carbamazepine has declined in the last 20 years, in favour of other antiepileptic drugs, but it was very widely used in the past. The effect of carbamazepine overdose has been described in the past e.g. doi: 10.2165/00002018-199308010-00010.
Author Response
We have included the reference mentioned in the text.
Reviewer 2 Report
The authors reported the case of a patient with acute carbamazepine and alprazolam intoxication, which is interesting from the point of view of the clinician.
However, there are some issues to be addressed
The most important of all – which were the plasmatic concentrations of alprazolam and carbamazepine detected in blood samples?
You reported a concentration for benzodiazepines (which benzodiazepines, aren’t we talking only about alprazolam?) of > 900 mg/dL) and of carbamazepine >46.3 mg/dL. I think these concentrations are much too high (I don’t think the patient would have survived at these concentrations). Please, double check.
Please mention the method used for detection.
I also don’t think it’s correct to use the title “Acute Carbamazepine Intoxication” – it’s an intoxication with both alprazolam and carbamazepine?
In addition:
Abstract
Please state clearly the aim of your manuscript
Please correct grammar
Introduction
Lines 20-22:
“Its mechanism of action is related to the blockade of pre- 20 synaptic voltage - dependent sodium channels [4], which at the same time could inhibit 21 the release of synaptic glutamate and possibly other neurotransmitters” – you mean blockade leading consequently to inhibition?
Please finish “Introduction” stating the aim of your manuscript
Case report
Line 53- PLEASE correct “flumazeine”. Flumazenil is the antidote for benzodiazepine poisoning.
Line 69- capitalize first letter
Discussion
I don’t think the purpose of reporting this case is clear. You say that the patient had a regular hart rate? Maybe you should point out that even cardiac arrythmias are frequent, this patient hadn’t had any. So it is possible this classical sign of carbamazepine intoxication is not present?
How was the hyperglycemia handled? Did the patient receive any medication for that? Or the blood glucose level just normalized in time? How much time?
Please use present or past tense in the manuscript. Right now they alternate and it’s confusing.
Author Response
This is just alprazolam. We added that a double check was given and the method of measuring the levels. The title used only refers to carbamazepine because we believe that the symptoms expressed by the patient are due to this drug. We have tried to improve the clarity and grammar of the manuscript according to the indications given, especially with respect to verb tenses, also correcting the aforementioned errors.
Reviewer 3 Report
It is an interesting report for a case of acute carbamazepine intoxication. Most of all, it should be required that the patient accept the case report in a manner of written consent form.
Author Response
We lost the follow up of the patient, so this point I am afraid is not possible to complete.
Reviewer 4 Report
This a case report based on an acute intoxication by the ingestion of carbamazepine. The case report is well-written; however, several changes should be made in the introduction and discussion sections to improve the paper prior to its publication.
In the introduction section, the authors report that the drug is mainly prescribed for the treatment of different neuropsychiatric disorders. I would expand this paragraph to clarify other indications and who is prescribing these drugs (general physicians, psychiatrists, neurologists, etc).
The mechanism of action has been described, majority in terms of pharmacodynamics. In the introduction section, I consider that it would be interesting to add some references about pharmacokinetics of the drugs. Which metabolizing enzymes are implicated in the metabolism of carbamazepine?
In the discussion section, it should be added that intoxication depends on both pharmacodynamics and pharmacokinetics of each drug.
I recommend to add two subsections explaining it. In the conclusions section, I consider necessary to remark both.
Author Response
Other indications for the drug are added, the mechanism of action of the drug is described, as well as the route of metabolism
Round 2
Reviewer 4 Report
The authors have improved the manuscript according to the Reviewer's recommendations. I consider that the paper can be accepted.
