Citalopram/lamotrigine overdose
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Serotonin syndrome: case report A 17-year-old girl developed serotonin syndrome following overdose of citalopram and lamotrigine for suicidal purpose . The girl presented to a hospital in Iran on 24 December 2018. Ten hour prior to presentation, she had ingested citalopram 400mg and lamotrigine 1000 mg tablets in an attempt to suicide. On presentation, she had a diaphoresis, nausea, shivering, agitation, vertigo, tremor and ataxia. Along with this, horizontal nystagmus and bilateral mydriasis were observed. She had a history of depression, for which, she was receiving half of the 20mg citalopram tablet and one-fourth of 50mg lamotrigine tablet daily. Bilateral deep tendon reflexes were found to be hyperactive, and myoclonuses in both lower extremities were observed. Her vital signs were as follows: heart rate 140/min, temperature 37.8°C, blood pressure 118/68 mm Hg, respiratory rate 30/min and finger pulse oximetry 97%. She was alert and reported dyspnoea and abdominal pain. A urine drug screen for stimulants, psychotropic substances were found negative. Laboratory examination revealed creatine phosphokinase 2438 and lactate dehydrogenase 464 [units not stated]. Other tests were normal, except ECG which showed sinus tachycardia. The girl was administered with midazolam and ondansetron for agitation and nausea. Later, she was administered with isotonic fluids. Her the signs and symptoms indicated serotonin toxicity (serotonin syndrome) and treatment with cyproheptadine was initiated. She was transferred to the ICU and kept under cardiopulmonary monitoring. On the following day, her neurological status and other symptoms improved. Subsequently, she was fully recovered and discharged on day 3. Dorooshi G, et al. Serotonin toxicity following suicide with citalopram and lamotrigine: A rare case report and literature review. Journal of Research in Pharmacy Practice 9: 803514259 158-160, No. 3, 08 Oct 2020. Available from: URL: http://doi.org/10.4103/jrpp.JRPP_19_105
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Reactions 14 Nov 2020 No. 1830
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