Seizure secondary to citalopram overdose

Cuenca, Peter J.; Holt, Kurtis Rex; Hoefle, Jeffrey David

doi:10.1016/j.jemermed.2003.06.005

Cited by 28 publications

(8 citation statements)

References 16 publications

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“…The ability of TCAs to be fatal in overdose has been well documented, with this concern contributing to the popularity of SSRIs. Whereas SSRIs are relatively safer than TCAs, SSRI overdose may still lead to serotonin toxicity, seizures, or dysrhythmias (Cuenca et al 2004;Isbister et al 2004), and fatalities have been reported following massive overdoses (Ostrom et al 1996) or after multiple-drug ingestion (Dalfen and Stewart 2001). Venlafaxine was also prescribed more frequently in patients with a history of suicide attempts.…”

Section: Discussionmentioning

confidence: 99%

Psychotropic Medication Utilization in a Child and Adolescent Mental Health Service

Dean¹,

McDermott²,

Marshall³

2006

Journal of Child and Adolescent Psychopharmacology

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Section: Discussionmentioning

confidence: 99%

Psychotropic Medication Utilization in a Child and Adolescent Mental Health Service

Dean¹,

McDermott²,

Marshall³

2006

Journal of Child and Adolescent Psychopharmacology

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“…There were several level 4 or 6 articles with individual case information presented in detail. Specifically, there were 12 cases reported in 11 articles (42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52). Among them, the lowest dose of citalopram associated with any toxicity was 400 mg, which was reported to be associated with severe toxicity in at least two adults (42,47).…”

Section: Citaloprammentioning

confidence: 99%

Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management

Nelson

Erdman

Booze

et al. 2007

Clinical Toxicology

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American Association of Poison Control Centers, Washington, District of Columbia, USAA review of US poison center data for 2004 showed over 48,000 exposures to selective serotonin reuptake inhibitors (SSRIs). A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidencebased expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments.The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial management of patients with a suspected ingestion of an SSRI by 1) describing the process by which an ingestion of an SSRI might be managed, 2) identifying the key decision elements in managing cases of SSRI ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to ingestion of immediate-release forms of SSRIs alone. Co-ingestion of additional substances might require different referral and management recommendations depending on their combined toxicities.This guideline is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment.Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses. 1) All patients with suicidal intent, intentional abuse, or in cases in which a malicious intent is suspected (e.g., child abuse or neglect) should be referred to an emergency department. This activity should be guided by local poison center procedures. In general, this should occur regardless of the dose reported (Grade D). 2) Any patient already experiencing any symptoms other than mild effects (mild effects include vomiting, somnolence [lightly sedated and arousable with speaking voice or light touch], mydriasis, or diaphoresis) should be transported to an emergency department. Transportation via ambulance should be considered based on the condition of the patient and the length of time it will take the patient to arrive at the emergency department (Grade D). 3) Asymptomatic patients or those with mild effects (defined above) following isolated unintentional acute SSRI ingestions of up to five times an initial adult therapeutic dose (i.e., citalopram 100 mg, escitalopram 50 mg, fluox...

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“…Our patient's signs of renal and hepatic injury are likely related to hypoperfusion during episodes of PEA and may have had some contribution by her hyperthermia. Seizures usually occur early in the course of a citalopram overdose [13], and their presence 24 h prior to presentation suggests an overdose at that time. The presence of ongoing seizures and temperature dysregulation may also have been related to persistent high drug levels and/or cerebral injury from hypoperfusion.…”

Section: Discussionmentioning

confidence: 99%

Citalopram Overdose: a Fatal Case

Kraai

Seifert

2014

J. Med. Toxicol.

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Background Citalopram is a selective serotonin reuptake inhibitor (SSRI) with cardiac and neurologic toxicities as well as the potential for serotonin syndrome. In most instances, patients recover fully from toxic ingestions of SSRIs. We describe a fatal case of a citalopram overdose. Case Report A 35-year-old woman presented to the emergency department after having witnessed seizures at home. An empty citalopram prescription bottle was located, and an intentional overdose was suspected. At the scene, she was found to be in cardiac arrest with pulseless electrical activity and underwent cardiopulmonary resuscitation, including intravenous epinephrine and bicarbonate. In the emergency department, her physical exam was notable for cough and gag reflexes and movement in all extremities with increased muscle tone and tachycardia. Her initial postresuscitation ECG showed sinus rhythm with QRS 92 ms and QTc 502 ms. Her temperature was initially normal, but she rapidly became febrile to 41.8°C shortly after admission. She was treated symptomatically and with cyproheptadine for suspected serotonin syndrome (SS) but became increasingly hemodynamically unstable over the next 6 h and then developed torsades des pointes (TdP) progressing to pulseless, wide complex tachycardia. She underwent cardiopulmonary resuscitation (CPR) for approximately 50 min but ultimately expired. Postmortem serum analysis revealed a citalopram concentration of 7300 ng/mL (therapeutic range 9-200 ng/mL) and THC, but no other nonresuscitation drugs or substances. Case Discussion Citalopram overdoses often have only mild to moderate symptoms, particularly with ingestions under 600 mg in adults. However, with higher doses, severe manifestations have been described, including QTc prolongation, TdP, and seizures. Serotonin syndrome has also been described in SSRI overdose, and our patient exhibited signs consistent with SS, including increased muscle tone and autonomic dysregulation. Our patient's serum concentration suggests a massive overdose, with major clinical effects, possible SS, and death. Conclusions Although most patients recover from citalopram overdose, high-dose ingestions can produce severe effects and fatalities may occur. In this case, it is likely that the patient's delayed presentation also contributed significantly to her death. The clinician must be aware of the potential for large ingestions of citalopram to produce life-threatening effects and monitor closely for the neurologic, cardiovascular, and other manifestations that, in rare cases, can be fatal.

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Seizure secondary to citalopram overdose

Cited by 28 publications

References 16 publications

Psychotropic Medication Utilization in a Child and Adolescent Mental Health Service

Psychotropic Medication Utilization in a Child and Adolescent Mental Health Service

Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management

Citalopram Overdose: a Fatal Case

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