Mirtazapine abuse
- PDF / 171,023 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 18 Downloads / 193 Views
1
S
Serotonin syndrome: case report A 39-year-old man developed serotonin syndrome with mirtazapine abuse and recreational use of sodium oxybate . The man was admitted in an ICU in May 2017. He was nonresponsive, but conscious, with bowel hyper-motility, tachycardia, diaphoresis, hypertension and hyperpyrexia. He had tremor, extremely high tone with clonus, pupils without proper reaction to light, hyperreflexia with nystagmus and mydriasis. Upon further enquiry it came to notice that, he took a high dose of recreational sodium oxybate [γhydroxybutyrate] after which his condition had deteriorated rapidly. He became agitated, unco-operative, started to shiver and hallucinate. Therefore, he was admitted in the emergency. As per his medical history, he was in outpatient psychiatric care because of sodium oxybate dependence, ecstasy and occasional cannabis abuse, insomnia and depression symptoms. He was previously on treatment with diazepam, valproate and mirtazapine. The toxicology results were positive for mirtazapine [route and dosage not stated], lidocaine, benzodiazepines, nicotine, sodium oxybate [γhydroxybutyrate], caffeine and traces of valproic acid. He had abused mirtazapine. Laboratory test revealed signs of liver impairment, signs of a mild renal insufficiency, leukocytosis, rhabdomyolysis and electrolyte disturbance. He was suspected for serotonin syndrome. The man was initiated on treatment with high doses of diazepam. After few days, he was not reacting to stimuli, unconscious and in muscular hypertonia with involuntary movements of his left leg and hand. After 4 days of intravenous diazepam treatment, his symptoms changed from the serotonin syndrome to severe sodium oxybate withdrawal with psychotic symptoms. He had verbalising delusions, hallucinations, agitation, restlessness, disorientation and communicated inadequately. The psychiatrist initiated him on haloperidol as well as switched the intravenous diazepam treatment to oral diazepam. After 8 days of the haloperidol and diazepam treatment, he became fully conscious and was in a stable physical condition. However, he was unable to recall the details of the intoxication. He stated that, he drank a large sip of concentrated recreational sodium oxybate after taking his usual diluted dose. He was transferred to a phsychiatric unit for treatment of sodium oxybate dependence. Author comment: "When it comes to other mechanisms that could lead to the development of serotonin syndrome in this particular case, we have considered the use and/or abuse of mirtazapine as a potential contributor." Bosnjak Kuharic D, et al. GHB roller-coaster: serotonin syndrome and withdrawal. Psychiatria Danubina 31: 371-373, No. 3, Sep 2019. Available from: URL: http:// 803438979 doi.org/10.24869/psyd.2019.371 - Croatia
0114-9954/19/1783-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 14 Dec 2019 No. 1783
Data Loading...
