Sertraline Intoxication in a Child

Kaminski, Christine A; Robbins, Maria Santeiro; Weibley, Richard E.

doi:10.1016/s0196-0644(94)70364-7

Cited by 69 publications

(19 citation statements)

References 6 publications

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“…Treatment included activated charcoal, physostigmine, acetaminophen, lorazepam, and chloral hydrate. After four days of hospitalization, the patient's serum sertraline level was <10 ng/mL and he was discharged home (11). Another case of reported sertraline toxicity involved a 5-year-old female who ingested at least eight, 50 mg sertraline tablets.…”

Section: Discussionmentioning

confidence: 99%

“…Pediatric dosing advice has been published, with a recommended dose of 0.25 mg/kg/day, divided into two to three doses but this regimen does not begin with a large loading dose which has been suggested as necessary for treatment of SS in adults; therefore we started treatment with an 8 mg dose in our case (2,14,15). In addition to cyproheptadine, benzodiazepines were also used among other cases, including our patient, to reduce hyperflexia and tremor (8,11). SS has previously been attributed to overdoses of SSRIs, tricyclic antidepressants, MAOIs, etc.…”

Section: Discussionmentioning

confidence: 99%

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Serotonin syndrome following a single 50 mg dose of sertraline in a child

Phan

Casavant

Crockett

et al. 2008

Clinical Toxicology

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Objective. To report a case of serotonin syndrome associated with a single, 50 mg dose of sertraline in a child and discuss the findings in context with previous relevant literature involving other selective serotonin reuptake inhibitors used in children. Case Summary. A nineyear old male with chronic behavioral problems was prescribed oral sertraline 50 mg daily. After the first dose, the patient presented with abdominal pain, seizure-like activity, and change in mental status. He was admitted to a tertiary-care pediatric hospital and was treated for serotonin syndrome. Laboratory findings of elevated creatine kinase and serum creatinine were consistent with rhabdomyolysis as result of continued hypertonicity. Sertraline was discontinued and treatment with lorazepam and cyproheptadine was initiated. Clinical status, creatine kinase, and serum creatinine improved over 5 days of hospitalization. The Adverse Drug Reaction Probability Scale by Naranjo et al was applied to assess causality. The scale indicated the association of a single dose of sertraline and serotonin syndrome as "probable." Conclusion. To our knowledge this is the first reported case of serotonin syndrome associated with a single dose of sertraline in a child using a validated causality scale. The sertraline 50 mg dose given to the child was higher than usual recommended initial doses (25 mg). This potential adverse reaction should be considered when selecting antidepressant therapy for children.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Serotonin syndrome following a single 50 mg dose of sertraline in a child

Phan

Casavant

Crockett

et al. 2008

Clinical Toxicology

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“…There were also a number of level 4 or 6 articles with individual case information on acute sertraline ingestions in patients 6 years of age and older. Specifically, there were 10 cases reported in nine articles (59,(92)(93)(94)(95)(96)(97)(98)(99). Among them, the lowest dose of sertraline associated with any toxicity was 750 mg ingested by a 42-year-old who had also ingested moclobemide, which resulted in moderate toxicity (59).…”

Section: Sertralinementioning

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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“…Sternbach 13 suggests that 3 criteria must be fulfilled in order to make the diagnosis. 1,9 First, the symptoms should occur in the setting of a recent addition or increase in dose of a serotomimetic agent. Second, other causes, such as infection, metabolic or endocrine disturbances, substance abuse or withdrawal, and recent neuroleptic use should be excluded.…”

Section: Discussionmentioning

confidence: 99%

“…1,[3][4][5][6][7] There are reports of serotonin syndrome occurring after overdoses of a single serotoninergic agent (usually an SSRI) and more rarely, after a single dose of an SSRI. 4,5,8,9 Serotonin syndrome has also occurred after combined overdoses involving serotoninergic agents This article has been peer reviewed.…”

Section: Introductionmentioning

confidence: 99%

Serotonin syndrome due to an overdose of moclobemide?

Renouf²

2002

CJEM

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Serotonin syndrome, a triad of autonomic instability, altered mental status and neuromuscular abnormalities, is usually attributed to serotonergic overdoses. Moclobemide is a new selective monoamine oxidase inhibitor (MAOI) that generally causes mild, self-limited gastrointestinal and central nervous system effects after ingestion. We present a case of serotonin syndrome that occurred after moclobemide overdose, and discuss the recognition and treatment of this important condition. Serotonin syndrome may become increasingly common because of the liberal use of selective serotonin reuptake inhibitors, new MAOIs and other agents such as codeine and meperidine, which have the potential for harmful interaction. RÉSUMÉLe syndrome sérotoninergique, une triade formée de symptômes neuro-végétatifs, cognitifs et neuro-musculaires, est habituellement attribuable à des intoxications sérotoninergiques. Le moclobémide est un nouvel inhibiteur sélectif de la monoamine-oxydase (IMAO) qui a généralement des effets indésirables bénins et spontanément résolutifs au niveau du tractus gastro-intestinal et du système nerveux central après l'ingestion. Nous présentons un cas de syndrome sérotonin-ergique découlant d'un surdosage au moclobémide et discutons de l'identification et du traitement de cette atteinte importante. Le syndrome sérotoninergique pourrait devenir de plus en plus courant avec l'usage répandu des inhibiteurs sélectifs du recaptage de la sérotonine, des nouveaux IMAO et autres agents comme la codéine et la mépéridine qui peuvent être la source d'interactions nocives.

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Sertraline Intoxication in a Child

Cited by 69 publications

References 6 publications

Serotonin syndrome following a single 50 mg dose of sertraline in a child

Serotonin syndrome following a single 50 mg dose of sertraline in a child

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

Serotonin syndrome due to an overdose of moclobemide?

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