Sir.—I read with interest the report by Drs Lehrman and Bauman (Journal 1981;135:768-769) of a carbamazepine overdose in a 14-year-old girl. They noted that a review of the literature disclosed no reports of intentional or accidental ingestion of large amounts of this drug, but then, rather surprisingly, mentioned Salcman and Pippenger's1 case of intentional overdosage in a 16-year-old boy with psychomotor seizures.
In 1974, my colleagues and I2 reported massive carbamazepine overdoses in two patients aged 14 and 18 years who took 5 g and 4 to 4.8 g of carbamazepine, respectively, and survived. In 1964, Hajnšek and Sartorius3 reported a case of carbamazepine intoxication in a 31-year-old woman who survived the ingestion of 100 tablets (20 g). Unfortunately, their patient's weight was not mentioned.
It has been found that the median lethal oral dose of carbamazepine is between 1,100 to 3,750 mg/kg in mice,4