Reactions 1254 - 30 May 2009

★ O SCitalopram overdose

Severe hypoglycaemia (first report) and seizures:2 case reports

Two women experienced severe hypoglycaemia andseizures after intentional ingestion of citalopramoverdoses.

A 20-year-old woman ingested about 2760mg ofcitalopram and presented to an emergency department90 minutes later. She smelt of alcohol, reported that shehad also ingested diazepam 10mg, and complained ofnausea and abdominal pain. Sinus tachycardia of100 beats/min was evident on ECG, and she had a bloodglucose level of 3.0 mmol/L. She experienced the first offour tonic clonic seizures 20 minutes later. After a secondseizure, a dextrose infusion was initiated. After the thirdseizure, she had fever of 38.4 and hypoglycaemia of1.9 mmol/L, and a dextrose bolus was administered.Seventy minutes later, she had a blood sugar level of3.8 mmol/L; she required a continuous dextrose infusionfor 22 hours to maintain her blood sugar level. A last brieftonic clonic seizure was observed on admission to theobservation ward. Over the next 24 hours, her blood sugarlevels stabilised and she required no further treatment.

A 37-year-old woman was brought to an emergencydepartment with reduced consciousness (Glasgow ComaScale score 10/15); empty citalopram packets had beenfound at the scene, but the ingested amount and time oftablet intake were unknown. On examination, she had apulse rate of 110 beats/min, a respiratory rate of22 breaths/min and a BP of 101/69. Further investigationsrevealed sinus tachycardia, a blood glucose level of3.3 mmol/L and respiratory acidosis with a pH of 7.234.Her blood glucose level increased during dextrose infusion,but decreased when the infusion was stopped. Dextrosewas restarted, with subsequent increase of her bloodglucose level, and she experienced a brief, self-resolvingtonic-clonic seizure 15 minutes later; at that time, herglucose level was 3.8 mmol/L. Her glucose level was1.7 mmol/L 30 minutes later, and a dextrose bolus wasadministered. Her blood glucose level continued tofluctuate for the next few hours, and then stabilised at4–5 mmol/L. The following day, she admitted ingesting acitalopram overdose and alcohol.

Author comment: "Clinically significant hypoglycaemiaand fluctuating blood sugar levels with associated convulsionsmay be a feature of citalopram poisoning."Duncan RA, et al. Severe hypoglycaemia in citalopram overdose. European Journalof Emergency Medicine: Official Journal of the European Society for EmergencyMedicine 15: 234-235, No. 4, Aug 2008 - Scotland 801141625

» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous reports ofhypoglycaemia associated with citalopram. The WHO ADRdatabase contained 88 reports of hypoglycaemia (WHO ART)associated with citalopram.

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Reactions 30 May 2009 No. 12540114-9954/10/1254-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved