quetiapine-fumarate and Shock

Methylene blue inhibits the nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway, decreasing vasodilation and increasing responsiveness to vasopressors. It is reported to improve haemodynamics in distributive shock from various causes including septicaemia and post-cardiac surgery. Reports of use in overdose are limited. We describe the use of methylene blue to treat a case of refractory distributive shock following a mixed drug poisoning.. A 41-year-old male presented following reported ingestion of 18 g extended-release quetiapine, 10 g controlled-release carbamazepine, 240 mg fluoxetine, 35 g enteric-coated sodium valproate and 375 mg oxazepam. He was comatose and intubated on presentation. Progressive hypotension developed. Echocardiogram revealed a hyperdynamic left ventricle, suggesting distributive shock. The patient remained hypotensive despite intravenous fluid boluses, escalating vasopressor infusions. Arterial blood gas revealed metabolic acidaemia and high lactate. Methylene blue was administered as loading-dose of 1.5 mg/kg and continuous infusion (1.5 mg/kg/h for 12 h, then 0.75 mg/kg/h for 12 h) resulting in rapid improvement in haemodynamic parameters and weaning of vasopressors. Serum quetiapine concentration was 18600 ng/mL (30-160 ng/mL), collected at the time of peak toxicity.. Severe quetiapine poisoning produces hypotension primarily from alpha-adrenoreceptor antagonism. Methylene blue may have utility in the treatment of distributive shock resulting from poisoning refractory to standard vasopressor therapy.

Topics: Adult; Anticonvulsants; Antidepressive Agents, Second-Generation; Antidotes; Antipsychotic Agents; Blood Gas Analysis; Blood Pressure; Carbamazepine; Dibenzothiazepines; Electrocardiography; Fluid Therapy; Fluoxetine; Humans; Hypnotics and Sedatives; Hypotension; Male; Methylene Blue; Oxazepam; Quetiapine Fumarate; Shock; Valproic Acid; Vasoconstrictor Agents

Quetiapine is an atypical antipsychotic medication that is increasingly being used in the treatment of psychotic disorders and depression. An overdose of quetiapine is associated with hypotension, sinus tachycardia, and sedation. The clinical effects of its overdose are often mild to moderate, but a severe overdose can cause cardiovascular collapse and death.Intravenous lipid emulsion (ILE) is a proposed treatment for potentially lethal cardiotoxicity after severe overdoses with lipophilic drugs, such as quetiapine, mainly by the sequestration of the lipophilic toxin to an expanded intravascular lipid phase.. To report a case where ILE was successfully used in the resuscitation of a patient with cardiovascular collapse after a severe quetiapine overdose.. A 42-year-old woman was admitted to the Emergency Department after being found unconscious at home, due to an estimated ingestion of 24 g of quetiapine (Seroquel). She was initially cardiorespiratory stable and unresponsive with a Glasgow Coma Scale of 3. The woman was immediately admitted to the Intensive Care Unit, where her condition quickly deteriorated. She was intubated, due to loss of airway. In addition, a gastric lavage was performed and activated charcoal was administered. The patient presented with cardiovascular collapse refractory to vasopressor treatment and volume resuscitation. ILE bolus followed by continuous infusion was administered. Her blood pressure started increasing 5 min after ILE was initiated and within an hour circulation was stabilized. The patient recovered completely without any residual symptoms, after 3 days in the ICU.. ILE may potentially be life-saving in cases of severe quetiapine poisoning and should be considered as a treatment for severe cardiovascular instability resulting from quetiapine poisoning refractory to maximum conventional therapy.

Topics: Adult; Antipsychotic Agents; Blood Pressure; Coma; Dibenzothiazepines; Drug Overdose; Fat Emulsions, Intravenous; Female; Humans; Quetiapine Fumarate; Resuscitation; Shock

The case of a 44-year-old female patient is reported, who ingested trimipramine and quetiapine in a suicide attempt. Initially sinus tachycardia and hypotension were seen, which resulted in a hypotensive cardio-circulatory failure despite fluid therapy and administration of catecholamines. Because of the life-threatening situation and the fact that the ingestion was 2 h prior to admission, a rapid transport to the next hospital was preferred to treatment with active charcoal. Intoxication with tricyclic antidepressants are very common in Europe and have a mortality of up to 15% in severe cases. The specific therapy consists of airway management, hemodynamic stabilization and primary elimination of the poison. Secondary detoxication is less important. The administration of the antidote physostigmine is controversial but carbo medicinalis should be given orally or via a gastric tube.

Topics: Adult; Antidepressive Agents; Antidotes; Antipsychotic Agents; Charcoal; Dibenzothiazepines; Electrocardiography; Female; Heart Failure; Humans; Hypotension; Quetiapine Fumarate; Shock; Suicide, Attempted; Trimipramine