Reactions 1517, p62 - 6 Sep 2014

O SCitalopram overdose

Various toxicities: case reportA 35-year-old woman developed various toxicities including

seizures, cardiac arrest, possible serotonin syndrome, andTorsades de Pointes after intentional overdose with citalopram[intake amount not stated].

The woman presented to the emergency department afterhaving witnessed seizures at home. An empty citalopramprescription bottle was located and intentional overdose wassuspected. At presentation she was found to be in cardiacarrest state with pulseless electrical activity.

The woman was treated with cardiopulmonary resuscitation(CPR), epinephrine and bicarbonate. In the emergencydepartment, she displayed gag reflexes, cough, movement inall her extremities with increased muscle tone and tachycardia.Her initial post-resuscitation ECG revealed sinus rhythm withQRS of 92 msecs and QTc of 502 msecs. Her bodytemperature was initially normal but she became febrileshortly after admission. She was treated symptomatically andwith cyproheptadine for suspected serotonin syndrome. Shebecame increasingly haemodynamically unstable over the next6 hours and subsequently developed Torsades de Pointes(TdP) progressing to pulseless, wide complex tachycardia. Shewas again given CPR without any improvement, and sheexpired.

Author comment: "However, with higher doses of[citalopram], severe manifestations have been described,including QTc prolongation, TdP and seizures. Serotoninsyndrome has also been described in SSRI overdose and ourpatient exhibited signs consistent with [Serotonin syndrome],including increased muscle tone and autonomicdysregulation."Kraai EP, et al. Citalopram overdose: A fatal case. Clinical Toxicology 52: 768,No. 7, Aug 2014. Available from: URL: http://doi.org/10.3109/15563650.2014.940163 [abstract] - USA 803107726

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Reactions 6 Sep 2014 No. 15170114-9954/14/1517-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved