Hyperprolactinemia may be present in patients with schizophrenic psychoses independent of antipsychotic medication. It might be stress induced. As enhanced prolactin can increase dopamine release through a feedback mechanism, this could contribute to explaining how stress can trigger the outbreak of psychosis.
We present a case of massive overdose with the atypical antipsychotic quetiapine in a 34-year-old woman (body weight 65 kg). At admission, approximately 2 to 4 hours after ingestion of approximately 24 g of quetiapine, the patient was comatose (Glasgow Coma Scale score 5), requiring orotracheal intubation and transfer to the intensive care unit. Because of myoclonic jerks and generalized seizures, benzodiazepines were administered. In addition to transient mild hypotension after intubation, the main cardiovascular manifestation was sinus tachycardia. The QT interval was normal, and the QTc interval (Bazett's correction) was maximally prolonged to 620 ms. However, no malignant arrhythmias were observed. The patient recovered within 2 days but remained agitated and aggressive, for which she was transferred to the psychiatric clinic. The pharmacokinetics of quetiapine in such a large overdose could not be described by simple first-order kinetics. The initially observed rapid decline of the plasma concentrations of quetiapine could be simulated by first-order kinetics (half life = 4.1 hr) and can most probably be explained by rapid distribution into tissues. The final elimination of the drug from the body occurred after approximately 34 hours at much slower rate, most probably reflecting redistribution from tissues into blood and consecutive hepatic clearance of the drug.
Apparently healthy persons (n = 425) s well s 264 patients characterized by an iron concentration in serum < 7.2 μιηοΐ/ΐ were examined. A latent iron deficiency was defined s a concentration of ferritin < 20 μg/l (males) and < 15 μ^Ι (females), without anaemia; manifest iron deficiency defined by an additional presence of hypochromic microcytic anaemia.Fifty-nine of 425 (= 14%) apparently healthy persons showed a latent iron deficiency. In the remaining 366 we established the following reference intervals for the concentration of transferrin in serum [μιηοΐ/ΐ]: 25.2-45.3 (males), 29.1-54.5 (females, < 25 years of age) and 25.3-48.6 (females, > 25 years of age). Eight of 59 (= 14%) apparently healthy persons with latent iron deficiency had a transferrin concentration above the reference interval.Sixty-one of 264 (= 23%) patients with an iron concentration < 7.2 μπιοΐ/ΐ showed a ferritin concentration < 20 μg/l (males) and < 15 μg/l (females). Thirty-eight of these 61 patients (= 62%) had a manifest iron deficiency. In 18 of these 38 patients (= 47%) the transferrin concentration was increased.For our 264 patients we determined the diagnostic validity of an increased transferrin concentration for diagnosis of iron deficiency, assuming an iron deficiency if the concentration of ferritin remained below the discrimination values mentioned above: The diagnostic sensitivity was 36%, the diagnostic specificity 97%, the predictive value of the positive test result 79% and the predictive value of the negative test result 83%.It can be concluded that the diagnostic validity of transferrin determination is inferior to that of ferritin measurement with respect to the diagnosis of iron deficiency. This especially applies to diagnostic situations in which the prevalence of iron deficiency is far lower than in the present study: e. g., given a prevalence of iron deficiency anaemia of 0.81% s it can be observed in the general population the predictive value of the positive test result only amounts to 11.3%.Thus, determination of transferrin conceiitratiori does not yield further Information, so that this test should no longer be used in the diagnosis of iron deficiency.n. o uc ιοη j ron faficiency is categorized s follows (for review see Iron deficiency is the most common deficiency caused j c o)): world-wide by faulty feeding. About 10-12% of all adults are characterized by a negative iron balance, in chil-(a) Prelatent iron deficiency is characterized by an indren the frequency is higher and in pregnant women the creased absorption of iron (e. g., in the course of the value is more than 50%. Iron deficiency anaemia makes 59 Fe 2 * whole-body retention test) s well s by a deup more than 70% of all kinds of anaemia (1).creased amount of stored iron within the bone marrow.
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