Citalopram overdose
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Serotonin syndrome following drug intoxication: case report A 42-year-old man developed serotonin syndrome (SS) due to drug intoxication following intentional overdose with citalopram for depression. The man had been diagnosed with depression for which he started receiving oral citalopram 20mg daily for previous 4 days. In addition, he had been taking non-pharmaceutical tryptophan-rich nutrient supplements and taurine-rich energy drink. He presented to the emergency department three hours prior to which he voluntarily ingested citalopram 480mg as well as alcohol with autolytic intention. Initially, he was awake, conscious but exhibited a marked hyperactivity with sialorrhoea, diaphoresis and bilateral and reactive mydriasis. Laboratory details were as follows: BP 168/100mm Hg, respiratory rate 48 breaths/min, axilar temperature 36°C and heart rate 110 bpm. The man received unspecified benzodiazepine with no response. His evolution was fulminant with progressive deterioration of agitation and increasing muscular rigidity as well as myoclonus, Babinsky bilateral sign, temperature 39°C, and increasing tachypnoea and tachycardia. He was found to have developed SS due to drug intoxication following intentional citalopram overdose. He was admitted to the ICU where he was intubated and mechanically ventilated. He developed multi-organ failure in a few hours with refractory shock, acute renal failure requiring continuous haemodiafiltration, lactic acidosis, disseminated intravascular coagulation and acute respiratory failure. Analytic evolution revealed cytolysis, hypoglycaemia, leukopenia and rhabdomyolysis. Microbiological cultures were negative. Following 72 hours, death due to SS was confirmed. The clinical autopsy was not performed. de Dios I, et al. The role of chronic nutritional supplements consumption in a fulminant serotonin syndrome due to citalopram intoxication. Medicina Intensiva 43: 582-583, 803500787 No. 9, Dec 2019. Available from: URL: http://doi.org/10.1016/j.medin.2017.11.011
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Reactions 12 Sep 2020 No. 1821
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