Late presentation of Torsades de Pointes related to fluoxetine following a multiple drug overdose
| Autor: | Leonore ten Bokum, Hubertus Laurentius Antonius van den Oever, Jan Albert Nicolaas Groot |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
medicine.medical_treatment Serotonin reuptake inhibitor Overdose Case Report Torsades de pointes 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Drug overdose QT interval Serotonin syndrome 03 medical and health sciences 0302 clinical medicine Torsades de Pointes Fluoxetine medicine Cardiopulmonary resuscitation Depression business.industry lcsh:Medical emergencies. Critical care. Intensive care. First aid lcsh:RC86-88.9 Emergency department Risperidone medicine.disease 030104 developmental biology Anesthesia medicine.symptom QTc prolongation business medicine.drug |
| Zdroj: | Journal of Intensive Care, Vol 6, Iss 1, Pp 1-6 (2018) Journal of Intensive Care |
| ISSN: | 2052-0492 |
| DOI: | 10.1186/s40560-018-0329-1 |
| Popis: | Background Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used in the treatment of depression. While most intoxications with SSRI’s have favorable outcomes and do not require interventions other than strict observation of vital signs and heart rhythm, clinicians should be aware of the life-threatening complications that may occur. Case presentation A 61-year-old woman presented to the emergency department after an intentional multiple drug overdose. Upon examination, she was somnolent with stable respiration and hemodynamics. Electrocardiography showed a prolonged QTc interval of 503 ms. The patient was admitted to the ICU for cardiopulmonary monitoring. During admission, the patient remained stable and showed improved neurologic function over time. After 22 h, a second ECG showed normalization of the QTc interval to 458 ms. However, 36 to 40 h after admission, our patient developed recurrent episodes of Torsades de Pointes (TdP) with loss of cardiac output, leading to cardiopulmonary resuscitation. Spontaneous circulation was restored after intravenous administration of magnesium sulphate. Retrospective serum analysis revealed fluoxetine concentrations of 2700 mcg/l. Conclusion Most intoxications with selective serotonin reuptake inhibitors (SSRI) have favorable outcomes and do not require medical interventions other than strict cardiopulmonary observation. However, higher doses have been associated with QTc interval prolongation, TdP, serotonin syndrome, and death. This case illustrates that life-threatening complications may occur late in the course of hospital admission. Even though overdoses with SSRI’s generally result in few fatalities, clinicians should be aware of the life-threatening clinical manifestations that may occur. Despite being an imperfect predictor of imminent TdP, continuous monitoring of cardiac rhythm is strongly recommended when either cardiac or non-cardiac symptoms are present. |
| Databáze: | OpenAIRE |
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