Olanzapine overdose
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Olanzapine overdose Various toxicities: case report.
A 55-year-old man developed stupor, somnolence, agitation, drug toxicity, agranulocytosis, muscular toxicity and respiratory failure following olanzapine overdose. The man had a history of psychosis. He was hospitalised 10 hours after overdose of olanzapine following ingestion of approximately 350mg of olanzapine. He had been receiving olanzapine 15mg daily for 2 years and was healthy. He had a history of episodes of unspecified antipsychotic-induced neutropenia. During admission, mentally he was fluctuating from stupor to somnolence with periods of agitation. His BP was 95/65mmHg, heart rate 130/min, oxygen saturation was 93%, WBC 3.04 x 109/L and and neutrophil count of 2.57 x 109/L. He had normal electrolytes and renal function with creatine kinase (CK) 10127 U/L (muscular toxicity). The serum concentration of olanzapine during admission was 0.40 mg/L (toxic >0.15 mg/L) suggestive of olanzapine toxicity. Initially, the man was treated with unspecified benzodiazepines, fluids, diuretics and bicarbonate. After 24 hours of the overdose, he became dyspneic, febrile and had respiratory failure. He was intubated, sedated and was put on mechanical ventilation for subsequent 6 days. Chest x-ray revealed bilateral consolidations. His WBC had dropped to 0.47 x 109/L and neutrophils dropped to 0.36 x 109/L. He was treated with unspecified antibiotics for febrile neutropenia. For 2 days granulocyte colony-stimulating factor (G-CSF) was administered. On day 3 of admission, WBC were 1.78 x 109/L and neutrophils were 1.40 x 109/L. On the subsequent day, WBC and neutrophils became normal. The concentration of olanzapine remained elevated for 6 days with 0.56 mg/L on day 2, 0.42 mg/L on day 3 and dropped to 0.25 mg/L on day 6. Following clinical, radiographic and aggressive support measures he became stable with regression in inflammation and regained his consciousness. On day 7, he was extubated. On the next day, CK value became normal. After 12 days of admission, he recovered completely and was transferred to the psychiatric department. Ercegovic GV, et al. Olanzapine overdose-induced agranulocytosis. Clinical Toxicology 58: 609-610, No. 6, Jan 2020. Available from: URL: http:// doi.org/10.1080/15563650.2020.1741981 [abstract]
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Reactions 26 Sep 2020 No. 1823
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