Late presentation of Torsades de Pointes related to fluoxetine following a multiple drug overdose
Abstract Background Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used in the treatment of depression. While most intoxications with SSRI’s have favorable outcomes and do not require interventions other than strict observation of vital signs and heart rhythm, clinicians shou...
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doaj-ab92a0eb8574448e8ca33cc1fc388b6a2020-11-25T01:27:01ZengBMCJournal of Intensive Care2052-04922018-09-01611610.1186/s40560-018-0329-1Late presentation of Torsades de Pointes related to fluoxetine following a multiple drug overdoseJan Albert Nicolaas Groot0Leonore ten Bokum1Hubertus Laurentius Antonius van den Oever2Intensive Care Unit, Deventer HospitalDepartment of Clinical Pharmacy, Deventer HospitalIntensive Care Unit, Deventer HospitalAbstract Background Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used in the treatment of depression. While most intoxications with SSRI’s have favorable outcomes and do not require interventions other than strict observation of vital signs and heart rhythm, clinicians should be aware of the life-threatening complications that may occur. Case presentation A 61-year-old woman presented to the emergency department after an intentional multiple drug overdose. Upon examination, she was somnolent with stable respiration and hemodynamics. Electrocardiography showed a prolonged QTc interval of 503 ms. The patient was admitted to the ICU for cardiopulmonary monitoring. During admission, the patient remained stable and showed improved neurologic function over time. After 22 h, a second ECG showed normalization of the QTc interval to 458 ms. However, 36 to 40 h after admission, our patient developed recurrent episodes of Torsades de Pointes (TdP) with loss of cardiac output, leading to cardiopulmonary resuscitation. Spontaneous circulation was restored after intravenous administration of magnesium sulphate. Retrospective serum analysis revealed fluoxetine concentrations of 2700 mcg/l. Conclusion Most intoxications with selective serotonin reuptake inhibitors (SSRI) have favorable outcomes and do not require medical interventions other than strict cardiopulmonary observation. However, higher doses have been associated with QTc interval prolongation, TdP, serotonin syndrome, and death. This case illustrates that life-threatening complications may occur late in the course of hospital admission. Even though overdoses with SSRI’s generally result in few fatalities, clinicians should be aware of the life-threatening clinical manifestations that may occur. Despite being an imperfect predictor of imminent TdP, continuous monitoring of cardiac rhythm is strongly recommended when either cardiac or non-cardiac symptoms are present.http://link.springer.com/article/10.1186/s40560-018-0329-1FluoxetineRisperidoneDepressionOverdoseQTc prolongationTorsades de Pointes |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jan Albert Nicolaas Groot Leonore ten Bokum Hubertus Laurentius Antonius van den Oever |
spellingShingle |
Jan Albert Nicolaas Groot Leonore ten Bokum Hubertus Laurentius Antonius van den Oever Late presentation of Torsades de Pointes related to fluoxetine following a multiple drug overdose Journal of Intensive Care Fluoxetine Risperidone Depression Overdose QTc prolongation Torsades de Pointes |
author_facet |
Jan Albert Nicolaas Groot Leonore ten Bokum Hubertus Laurentius Antonius van den Oever |
author_sort |
Jan Albert Nicolaas Groot |
title |
Late presentation of Torsades de Pointes related to fluoxetine following a multiple drug overdose |
title_short |
Late presentation of Torsades de Pointes related to fluoxetine following a multiple drug overdose |
title_full |
Late presentation of Torsades de Pointes related to fluoxetine following a multiple drug overdose |
title_fullStr |
Late presentation of Torsades de Pointes related to fluoxetine following a multiple drug overdose |
title_full_unstemmed |
Late presentation of Torsades de Pointes related to fluoxetine following a multiple drug overdose |
title_sort |
late presentation of torsades de pointes related to fluoxetine following a multiple drug overdose |
publisher |
BMC |
series |
Journal of Intensive Care |
issn |
2052-0492 |
publishDate |
2018-09-01 |
description |
Abstract Background Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used in the treatment of depression. While most intoxications with SSRI’s have favorable outcomes and do not require interventions other than strict observation of vital signs and heart rhythm, clinicians should be aware of the life-threatening complications that may occur. Case presentation A 61-year-old woman presented to the emergency department after an intentional multiple drug overdose. Upon examination, she was somnolent with stable respiration and hemodynamics. Electrocardiography showed a prolonged QTc interval of 503 ms. The patient was admitted to the ICU for cardiopulmonary monitoring. During admission, the patient remained stable and showed improved neurologic function over time. After 22 h, a second ECG showed normalization of the QTc interval to 458 ms. However, 36 to 40 h after admission, our patient developed recurrent episodes of Torsades de Pointes (TdP) with loss of cardiac output, leading to cardiopulmonary resuscitation. Spontaneous circulation was restored after intravenous administration of magnesium sulphate. Retrospective serum analysis revealed fluoxetine concentrations of 2700 mcg/l. Conclusion Most intoxications with selective serotonin reuptake inhibitors (SSRI) have favorable outcomes and do not require medical interventions other than strict cardiopulmonary observation. However, higher doses have been associated with QTc interval prolongation, TdP, serotonin syndrome, and death. This case illustrates that life-threatening complications may occur late in the course of hospital admission. Even though overdoses with SSRI’s generally result in few fatalities, clinicians should be aware of the life-threatening clinical manifestations that may occur. Despite being an imperfect predictor of imminent TdP, continuous monitoring of cardiac rhythm is strongly recommended when either cardiac or non-cardiac symptoms are present. |
topic |
Fluoxetine Risperidone Depression Overdose QTc prolongation Torsades de Pointes |
url |
http://link.springer.com/article/10.1186/s40560-018-0329-1 |
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