Venlafaxine overdose
- PDF / 152,086 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 13 Downloads / 129 Views
1 OS
Various toxicities secondary to drug toxicity: case report A 44-year-old woman developed cardiomyopathy, dilated pupils, myoclonic jerks, tonic-clonic seizures, left ventricular failure, increased lactate, delirium and prolongation QRS complex secondary to drug toxicity following an overdose with venlafaxine. The woman ingested 25.2g of venlafaxine extended release within 4 hours prior to admission. Additionally, she received temazepam concomitantly. Initially, she had tachycardia and disoriented. At 2 hours following admission, she developed myoclonic jerks and dilated pupils. Over the next 4 hours, she reported three generalized tonic-clonic seizures. The woman was treated with midazolam and diazepam. Following the final seizure, she reported Glasgow Coma Scale of 6, BP of 80/60mm Hg, heart rate of 98 beats per minute with increased lactate of 3.1 mmol/L. The woman was treated with metaraminol and crystalloid, and she was intubated. Charcoal [activated charcoal] was administered via nasogastric tube. After one hour, the BP decreased again to 64/40 mmHg despite an additional litre of crystalloid, and therefore a norepinephrine [noradrenaline] infusion was started. She had developed left ventricular (LV) failure confirmed by transthoracic ECG revealing global LV systolic dysfunction. The oxygen saturation was observed to be 90% on positive end-expiratory pressure (PEEP) 7cm water (H2O) and fraction of inspired oxygen (FiO2) 90%. High-dose insulin euglycemic therapy (HIET) was then started with insulin [Actrapid] along with glucose [dextrose]. Her systolic BP stabilised over the next 5 hours with insulin and norepinephrine able to be reduced to 1.3 mg/min. At 9 hours, post-presentation her lactate again increased peaking at 4.3 mmol/L with nadir pH 7.29, with resolution without additional treatment by 16 hours. ECG revealed QRS complex prolongation. It was reported that venlafaxine concentration peaked at 44,197 mg/L at 10h. Whole bowel irrigation was given at 10 hours with tablets noted in the effluent within 4 hours. A new ECG at 12 hours revealed an improved LV ejection fraction. Subsequently, ECG changes resolved at 21 hours, and insulin and norepinephrine were stopped at 22 hours. Glucose infusion was continued for at least 12 hours postcessation of HIET. She was extubated at 40 hours and delayed due to delirium. Consequently, she was discharged home with a complete neurological recovery on day 14. Stefani M, et al. High-dose insulin euglycemic therapy to treat cardiomyopathy associated with massive venlafaxine overdose. Clinical Toxicology 58: 299-300, No. 4, Apr 803515151 2020. Available from: URL: http://doi.org/10.1080/15563650.2019.1638930
0114-9954/20/1830-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 14 Nov 2020 No. 1830
Data Loading...
