| Citalopram overdose: late presentation of torsades de pointes (TdP) with cardiac arrest. | |
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MedLine Citation:
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PMID: 18570170 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: Citalopram overdose may produce bradycardia, QT prolongation, and torsades de pointes (TdP). A cardiotoxic metabolite may be responsible for the delayed onset of cardiotoxicity. Although some authorities recommend a minimum of 24 hours of observation following citalopram overdose, a recent analysis suggested that dysrhythmias rarely occur beyond 13 hours post-ingestion. We present a case of citalopram overdose with a substantially delayed onset of cardiac toxicity. CASE REPORT: A 36-year-old woman complained of shakiness, numbness in the arms, and palpitations that began approximately 32 hours after ingesting 50 (20-mg) tablets of citalopram. Her initial vital signs were: blood pressure, 84/44 mmHg; pulse, 102-150/minute; respirations, 17/min; temperature, 99.3 degrees F (37.3 degrees C). Her initial ECG showed sinus rhythm with a prolonged corrected QT interval (572 msec) with paroxysmal, self-limited runs of wide-complex tachycardia that appeared multifocal in nature. Approximately 20 minutes after presentation, she experienced self-terminating TdP, with transient hypotension and loss of consciousness. Her serum citalopram concentration (33 hours post-ingestion) was 477 ng/mL (therapeutic: 40-110 ng/mL); desmethylcitalopram concentration was 123.2 ng/mL (therapeutic: 14-40 ng/mL). She was treated with magnesium and lidocaine, and her corrected QT interval remained abnormal for 24 hours after presentation. DISCUSSION: Citalopram overdose can produce life-threatening cardiac toxicity with a clinical onset that may be delayed beyond a routine observation period of 6 hours. Once the QT interval is prolonged, it seems prudent to prolong the observation period. |
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Authors:
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Asim F Tarabar; Robert S Hoffman; Lewis Nelson |
Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Journal of medical toxicology : official journal of the American College of Medical Toxicology Volume: 4 ISSN: 1556-9039 ISO Abbreviation: J Med Toxicol Publication Date: 2008 Jun |
Date Detail:
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Created Date: 2008-06-23 Completed Date: 2008-09-09 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101284598 Medline TA: J Med Toxicol Country: United States |
Other Details:
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Languages: eng Pagination: 101-5 Citation Subset: IM |
Affiliation:
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Yale University School of Medicine, New Haven, CT, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anti-Arrhythmia Agents / therapeutic use Antidepressive Agents, Second-Generation / blood, poisoning* Citalopram / blood, poisoning* Electrocardiography Female Heart Arrest / chemically induced*, drug therapy, physiopathology Humans Lidocaine / therapeutic use Magnesium Sulfate / therapeutic use Overdose Serotonin Uptake Inhibitors / blood, poisoning* Suicide, Attempted Time Factors Torsades de Pointes / chemically induced*, drug therapy, physiopathology Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anti-Arrhythmia Agents; 0/Antidepressive Agents, Second-Generation; 0/Serotonin Uptake Inhibitors; 137-58-6/Lidocaine; 59729-33-8/Citalopram; 7487-88-9/Magnesium Sulfate |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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