Lithium/venlafaxine overdose
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Poisoning: case report A 41-year-old woman who ingested lithium and venlafaxine in a suicide attempt developed lithium and venlafaxine poisoning. The woman, who had depressive disorder and psychoorganic syndrome, had received lithium and venlafaxine for several months. She intentionally ingested about 30g of lithium tablets and 2100mg of venlafaxine tablets. She vomited several times about 30 minutes after ingestion. On presentation at the emergency department 4.5 hours after selfpoisoning, she received charcoal, gastric lavage and a salinic laxative, before hospitalisation 5 hours after self-poisoning. At admission, her serum lithium level was >5 mmol/L; her HR was 80/minute and her QTc interval was 475 milliseconds. She received crystalloids during 48 hours in the ICU; her clinical condition was normal, and her QTc interval normalised. She was transferred to the Department of Psychiatry; she received IV fluids. She had minimal tremor of the extremities. Her clinical condition deteriorated during the following 15 hours. She was re-admitted to the ICU with confusion, disorientation, muscle fasciculations, restlessness and tremor and tachypnoea. Her serum lithium level was 2.13 mmol/L. The woman received crystalloids, midazolam and propofol, and started continuous veno-venous haemofiltration. Her condition improved after a few hours of renal replacement therapy. She became oriented, but her tremor and slurred speech remained for the following 3 days, and she remained unable to swallow; a nasogastric tube was inserted. Her clinical signs of lithium poisoning resolved after the next few days. She received levothyroxine sodium for newly-diagnosed hypothyrosis and lorazepam for depression. On transfer from the ICU after 5 days, her serum lithium level was 0.15 mmol/L. She completely physically recovered during 5 days on an ordinary ward. Author comment: "We treated a patient after a suicidal attempt with lithium and venlafaxin, who developed clinical signs of nothing but lithium poisoning with a substantial delay . . . QTc may be erroneously high in patients with tachycardia in venlafaxine overdose . . . We ascribed the symptoms and signs at the second admission to Intensive care unit to lithium poisoning . . . chronic lithium therapy may inhibit thyroid hormone release, resulting in hypothyrosis". Sinkovic A, et al. Lithium and venlafaxine poisoning - A case report. Central European Journal of Medicine 8: 591-596, No. 5, Oct 2013. Available from: URL: 803095858 http://dx.doi.org/10.2478/s11536-013-0191-4 - Slovenia
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Reactions 23 Nov 2013 No. 1479
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