Multiple drugs overdose
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Hemodynamic instability and serotonin toxicity: case report A 70-year-old woman developed hemodynamic instability following a overdose of amlodipine, candesartan cilexetil, propiomazine and oxazepam, and serotonin toxicity while receiving methylthioninium chloride for vasodilatory shock and fentanyl and overdose of citalopram [not all dosages, routes and indications stated]. The woman was found obtunded following an overdose of multiple drugs. She had access to propiomazine, oxazepam and to her husband’s amlodipine, candesartan and citalopram. On admission, her condition was suggestive of hemodynamic instability due to amlodipine and candesartan-cilexetil poisoning. The woman was treated with norepinephrine, vasopressin and insulin. However, 18 hours after arrival, vasopressin and insulin were discontinued, and she started receiving methylthioninium chloride [methylene blue] 2 mg/kg followed by a continuous infusion of 0.5 mg/kg/h for refractory vasodilatory shock. Her blood pressure remained low. After 22 hours of arrival, she also developed non-cardiogenic pulmonary edema, which required intubation. She also developed spontaneous clonus and muscle rigidity in the lower extremities and jaw, which lead to break her dental bridge while biting down on the endotracheal tube. She also became diaphoretic and her body temperature increased to 39°C. Her symptoms were consistent with serotonin toxicity secondary to methylthioninium chloride, fentanyl and ingestion of citalopram overdose. Methylthioninium chloride and fentanyl were discontinued, and she was treated with olanzapine. Within an hour of treatment, spontaneous clonus had resolved along with body temperature decreased to 37.5°C. Gunnervik M, et al. Crisis averted? Olanzapine as an antidote for serotonin toxicity: A case report. Clinical Toxicology 58: 629, No. 6, 2020. Available from: URL: http:// doi.org/10.1080/15563650.2020.1741981 [abstract] 803502939
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Reactions 26 Sep 2020 No. 1823
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