Biodetoxification Using Intravenous Lipid Emulsion, a Rescue Therapy in Life-Threatening Quetiapine and Venlafaxine Poisoning: A Case Report
Abstract
:1. Introduction
2. Case Report
3. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Timeframe (hours following ingestion) | 0 | 12 | 14 | 16 | 18 | 20 | 22 | 24 | 48 | 55 | 72 | 96 | 120 |
Lactate (mmol/L) | 5.3 | 4.3 | 3.6 | 4.7 | 3.5 | 3.3 | 3.1 | 2.2 | 3.6 | 2.0 | 1.5 | 1 | |
Noradrenaline (mcg/kg/min) | 0.25 | 0.4 | 0.14 | 0 | 0 | 0 | 0.2 | 0.13 | 0 | 0 | |||
QTc (ms) | 456 | 510 | 503 | 480 | 440 | ||||||||
ILE therapy | * | ** |
Reference | Drug | Symptoms | ILE Dose | Timing ILE Therapy | Clinical Outcome |
---|---|---|---|---|---|
Finn et al. [30] | Quetiapine and sertraline | GCS 3 points | 20% lipid emulsion IV bolus dose of 1.5 mL/kg (100 mL) followed by an infusion of 6 mL/kg (400 mL) | 4 h after ingestion | Rapid and sustained rise in consciousness (GCS 9) occurred simultaneously with ILE therapy |
Bartos and Knudsen [31] | Quetiapine | Cardiovascular collapse refractory to vasopressor treatment and volume resuscitation | 20% lipid emulsion IV bolus dose of 170 mL followed by an infusion of 500 mL 20% lipid emulsion run over 1 h | Within the first hour, vasopressor requirement decreased and no further boluses of either epinephrine or phenylephrine were required | |
Engin et al. [32] | Quetiapine | Depressed consciousness, tachycardia, and hypotension | Two 1.5-mL/kg 20% lipid emulsion IV bolus doses 15 min apart with no infusion drip | One hour after admission to the ICU, ILE therapy was considered to prevent further complications | Symptoms improved |
Cevik et al. [9] | Quetiapine | Hypotension and sinus tachycardia | 100 mL 20% lipid emulsion IV bolus, followed by 30 mL kg/h infusion over 2 h (total dose of 3580 mL) | Hypotension and tachycardia regressed two hours after ILE treatment | |
Hieger et al. [33] | Quetiapine | Status epilepticus and cardiovascular collapse | 1.5-mL/kg 20% lipid emulsion IV bolus over 5 min, then a drip at 0.25 mL/kg/min (total dose 2000 mL) | 11 h after ingestion | Norepinephrine was discontinued |
Harvey et al. [34] | Mixed overdose, including Quetiapine and Amitriptyline | Hemodynamic instability with prolonged QRS and QTc | 100 mL 20% lipid emulsion IV bolus over 1 min followed by a further 400 mL over 30 min | Hemodynamics improved, QRS and QTc normalized | |
Purg et al. [11] | Quetiapine, Citalopram, Bromazepam | Life-threatening arrhythmia (prolonged QTc followed by PVC and VT with pules) and status epilepticus | 1.5 mL/kg (100 mL) 20% lipid emulsion IV bolus over 10 min, followed by an additional 200 mL over the next hours | 12 h after admission | After ILE, QTc normalized, and ventricular tachycardia and seizures stopped |
De Wit et al. [35] | Venlafaxine | MODS and refractory shock | 1.5 mL/kg (120 mL) 20% lipid emulsion IV as a single bolus dose | 40 h after presumed ingestion | Following the administration of the intravenous lipid emulsion, there was a notable improvement in the patient’s clinical condition |
Dagtekin et al. [36] | Venlafaxine, Lamotrigine, Diazepam | Rigidity, hyperreflexia, and reflex myoclonia | 2.5 mL/kg (150 mL) IV bolus of 20% lipid emulsion | 8 h after admision in ICU | Symptoms improved after infusion started |
Hillyard et al. [37] | Venlafaxine, Zopiclone | A decline in GCS to 3 points | 1.5 mL/kg (100 mL) 20% lipid emulsion IV bolus dose followed by a 400 mL infusion over the next 40 min | 30 min after infusion started, his GCS improved to 11 points and was 14 after 3 h | |
Blixt et al. [38] | Venlafaxine | Refractory cardiovascular collapse and PEA cardiac arrest | 1.5 mL/kg 20% lipid emulsion IV bolus in 60 s followed by an infusion at a rate of 0.25 mL/kg/min over 60 min | No further PEA or cardiac arrest episodes occurred |
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Cobilinschi, C.; Mirea, L.; Andrei, C.-A.; Ungureanu, R.; Cotae, A.-M.; Avram, O.; Isac, S.; Grințescu, I.M.; Țincu, R. Biodetoxification Using Intravenous Lipid Emulsion, a Rescue Therapy in Life-Threatening Quetiapine and Venlafaxine Poisoning: A Case Report. Toxics 2023, 11, 917. https://doi.org/10.3390/toxics11110917
Cobilinschi C, Mirea L, Andrei C-A, Ungureanu R, Cotae A-M, Avram O, Isac S, Grințescu IM, Țincu R. Biodetoxification Using Intravenous Lipid Emulsion, a Rescue Therapy in Life-Threatening Quetiapine and Venlafaxine Poisoning: A Case Report. Toxics. 2023; 11(11):917. https://doi.org/10.3390/toxics11110917
Chicago/Turabian StyleCobilinschi, Cristian, Liliana Mirea, Cosmin-Andrei Andrei, Raluca Ungureanu, Ana-Maria Cotae, Oana Avram, Sebastian Isac, Ioana Marina Grințescu, and Radu Țincu. 2023. "Biodetoxification Using Intravenous Lipid Emulsion, a Rescue Therapy in Life-Threatening Quetiapine and Venlafaxine Poisoning: A Case Report" Toxics 11, no. 11: 917. https://doi.org/10.3390/toxics11110917