Escitalopram overdose
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Serotonin syndrome secondary to escitalopram toxicity following a deliberate ingestion of escitalopram in an overdose: case report An 82-year-old man developed serotonin syndrome secondary to escitalopram toxicity following a deliberate ingestion of escitalopram in an overdose. This case was reported via Vigiflow at WHO-UMC with Id-2019-38323. The man was brought to the emergency department of a hospital located in India with an altered sensorium. His CNS examination was significant for delirium. He was found to have tachycardia, hypertension, restlessness and agitation. He was kept under observation due to the suspicion of hyponatraemia or CNS problem. His ECG showed a HR of >110 /min but heart rhythm was found to be normal. An arterial blood gas analysis was also found to be normal. His sodium level was 141 mEq/L. After 1 hour, he did not regain consciousness. Therefore, a CT scan of the brain was performed which did not reveal any significant finding. He was initiated on sodium chloride [normal saline] and was shifted to the ICU for further management. On detailed history, his relative told that he (the patient) was alright in the evening on previous day and did not wake up in the morning. On arousal, he was not following verbal command so he was brought to the hospital. On month prior to the admission, he had been diagnosed with an underlying adjustment disorder with depressed mood. He had been receiving escitalopram 10mg tablets once daily and zolpidem since the diagnosis of adjustment disorder with depressed mood. He had a history of diabetes mellitus and hypertension since 15 years so he had been receiving voglibose treatment with voglibose and amlodipine. After 3 hours of admission, he continued to have tachycardia and hypertension. Therefore, overdose/toxicity of selective serotonin reuptake inhibitors (SSRIs) was suspected. The man’s therapy with escitalopram and zolpidem were discontinued. Ryle’s tube was inserted and gastric sample collected and stomach wash done with sodium chloride [normal saline]. Furosemide was also given. Urinary catheter was inserted and urine drug abuse assay was done which excluded other drug overdose. In the ICU, he received treatment with ceftriaxone, pantoprazole, ondansetron, Optineuron, amlodipine and voglibose. A 2D echo was found to be normal. His complete blood count, serum electrolytes, liver function test, renal function test and the chest x-ray were found to be normal. His condition subsequently improved. He regained consciousness on 2nd day with a pulse rate of 92 /min regular and a BP of 120/70mm Hg. On detailed inquiry, he reported a deliberate ingestion of 4 tablets of escitalopram 10mg in the night before admission. After consultation with the psychiatric department, he was advised to continue escitalopram 10mg tablets and zolpidem. He was conscious and psychologically stable. Therefore, he was discharged on 4th day of admission. Lad DH, et al. Serotonin syndrome precipitated by escitalopram. Indian Journal of Forensic Medicine and Toxicology 14: 79-82, No.
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