Bicarbonate refractory QRS prolongation and left bundle‐branch block following escitalopram and lamotrigine overdose: A case report and literature review of toxic left bundle‐branch block

Farkas, Andrew; Marcott, M.; Yanta, Joseph H.; Pizon, Anthony F.

doi:10.1111/jcpt.12698

Cited by 8 publications

(2 citation statements)

References 18 publications

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“…Furthermore, in clinical practice, it may be possible to prevent drug overdose by paying attention to the appropriate number of drugs in stock and the use of the drug itself according to the number of prescription days, but verification with a larger sample group is required. Toxicity of anticonvulsants and antipsychotics includes central nervous system depression and cardiotoxicity, which are fatal [ 30 , 37 – 41 ]. Some reports stated that meropenem is effective as an antidote for an overdose of sodium valproate [ 42 , 43 ], and an intravenous injection of lipid emulsion is effective in detoxifying cardiotoxicity due to an overdose of quetiapine [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship between tracheal intubation and the drugs used by patients with drug overdose due to self-harm

Nagashima

Hosono

Watanabe

2022

J Pharm Health Care Sci

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Background Tracheal intubation may be performed in patients with drug overdose due to self-harm; however, the details of the causative drug are unknown. The purpose of this study was to clarify the relationship between drugs or its blood levels of patients with drug overdose and the need for tracheal intubation based on the actual measurement results. Methods From October 2018 to March 2020, 132 patients with drug overdose due to self-harm who were transported to the emergency department (ED) were studied. Patient drugs were measured using gas chromatography–mass spectrometry (GC-MS) and were analyzed on the basis of the GC/MS Forensic Toxicological Database. Logistic analysis was performed by combining patient information and GC-MS information. Results The Glasgow Coma Scale (GCS) and Japan Coma Scale (JCS) efficiently predicted tracheal intubation in patients with drug overdose during transport triage; GCS (cut-off value: 12, area under the curve (AUC): 0.81, 95% confidence interval (CI): 0.71–0.88, sensitivity: 0.85, specificity: 0.71, P < 0.05) and JCS (cut-off value: 3, AUC: 0.74, 95% CI: 0.60–0.84, sensitivity: 0.60, specificity: 0.84, P < 0.05). The drugs detected in all patients with drug overdose in order were benzodiazepine receptor agonists (BZs; 43.9%), anticonvulsants (38.6%), antipsychotics (25.0%), and antidepressants (9.8%). In univariate logistic analysis, antipsychotics (odds ratio (OR) 2.46, 95% CI 1.19–5.20, P < 0.05), anticonvulsants (OR 2.71, 95% CI 1.26–5.98, P < 0.05), and anticonvulsants above alert blood levels (OR 27.8, 95% CI 2.92–264.1, P < 0.05) were significantly associated with tracheal intubation in patients with drug overdose, but not BZs and antidepressants. Also, in multivariate logistic analysis, antipsychotics (OR 2.27, 95% CI 1.07–4.83, P < 0.05), anticonvulsants (OR 2.50, 95% CI 1.14–5.64, P < 0.05) and in multivariate logistic analysis of blood levels, anticonvulsants above the alert blood levels (OR 24.9, 95% CI 2.56–241.6, P < 0.05) were significantly associated with tracheal intubation in patients with drug overdose respectively. Conclusions Logistic analysis revealed that the use of anticonvulsants and antipsychotics were significantly associated with an increased OR in the tracheal intubation of patients with drug overdose due to self-harm.

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Section: Discussionmentioning

confidence: 99%

Relationship between tracheal intubation and the drugs used by patients with drug overdose due to self-harm

Nagashima

Hosono

Watanabe

2022

J Pharm Health Care Sci

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“…By definition, transient bundle branch block (BBB) is an intraventricular conduction defect that subsequently returns to normal conduction. In contrast, an intermittent BBB is a complex that demonstrates BBB as well as normally conducted beats in a single electrocardiographic tracing [ 3 - 7 ].…”

Section: Discussionmentioning

confidence: 99%

Transient Left Bundle Branch Block in the Setting of Cardiogenic Pulmonary Edema

Elgassim¹,

Sanosi²,

Elgassim³

2021

Cureus

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Escitalopram/lamotrigine overdose

2018

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Bicarbonate refractory QRS prolongation and left bundle‐branch block following escitalopram and lamotrigine overdose: A case report and literature review of toxic left bundle‐branch block

Abstract: Cases of toxic LBBB are less likely to respond to bicarbonate therapy, suggesting that this finding is due to a mechanism other than sodium channel blockade.

Cited by 8 publications

References 18 publications

Relationship between tracheal intubation and the drugs used by patients with drug overdose due to self-harm

Relationship between tracheal intubation and the drugs used by patients with drug overdose due to self-harm

Transient Left Bundle Branch Block in the Setting of Cardiogenic Pulmonary Edema

Escitalopram/lamotrigine overdose

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