Letter to the Editor: A Suspicious Bathtub Death in a Suicidal Patienton Mirtazapine

Sauvageau, Anny

doi:10.1080/15563650500394985

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…There is limited and conflicting information on the effect of mirtazapine in overdose, including case studies suggesting that it causes ‘serotonin syndrome’, suggestions of an association with rhabdomyolysis and a handful of post-mortem cases of suicides positive for high concentrations of mirtazapine in bodily fluids. 4–7 In contrast, other studies have suggested it is relatively non-toxic. 2 , 8–13 …”

Section: Introductionmentioning

confidence: 94%

Mirtazapine overdose is unlikely to cause major toxicity

Berling

2013

Clinical Toxicology

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Objective. There is limited information on mirtazapine overdose, but cases of severe effects (seizures, serotonin toxicity and coma) have been reported. We aimed to investigate the clinical effects and complications of mirtazapine overdose. Methods. This was an observational case series of mirtazapine overdoses (> 120 mg) identified from admissions to a toxicology unit between January 1987 and August 2013. Demographic information, details of ingestion, clinical effects, ECG parameters (HR, QT and QRS), and length of stay were extracted from a clinical database. Results. From 267 mirtazapine overdoses, there were 89 single-agent mirtazapine ingestions and 178 cases where mirtazapine was taken with at least one other drug. The median age of the 89 single-agent mirtazapine ingestions was 36 years [interquartile range (IQR): 26–49 years; Range: 15–81 years]; 45 were female (51%). The median ingested dose was 420 mg (IQR: 270–750 mg; Range: 150–1350 mg) and 41 patients (46%) had a Glasgow coma score (GCS) < 15, but the minimum GCS was 10. There were no seizures, serotonin toxicity or delirium. Tachycardia occurred in 29 patients (33%) and hypertension in 32 patients (36%). The median QRS was 80 ms (Range: 80–120 ms) and there were no cases with QT prolongation. There were no arrhythmias and no deaths. The median length of stay was 14 h (IQR: 8.8–18.2 h; Range:2.2–75 h). No single-agent mirtazapine patient was admitted to intensive care. The 178 patients taking co-ingestants had more severe toxicity depending on the co-ingested drug. Conclusion. Mirtazapine appears to be relatively benign in overdose, associated with tachycardia, mild hypertension and mild CNS depression not requiring intervention.

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Section: Introductionmentioning

confidence: 94%

Mirtazapine overdose is unlikely to cause major toxicity

Berling

2013

Clinical Toxicology

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“…Suicidal deaths are probably commoner than is appreciated or acknowledged (54,74). Drowning has been reported to be a relatively common method of suicide among children and adolescents (53).…”

Section: Diagnostic Difficulties and Questionsmentioning

confidence: 99%

Forensic investigation of submersion deaths

Papadodima¹,

Athanaselis²,

Skliros³

et al. 2010

International Journal of Clinical Practice

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A complete autopsy, histopathological examination and full toxicological screening are important to determine whether death indeed followed submersion in the water, or to see whether any natural disease or substance use have contributed or caused death. In ambiguous situations, the co-estimation of circumstantial evidence may be of invaluable importance toward the conclusion concerning the cause and the manner of death. The thorough forensic investigation of the submersion deaths not only serves the justice administration, but it also presents considerable benefits for the public health.

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