Velazquez C, Carlson A, Stokes K A, Leikin J B
Washington University, St Louis, MO 63110, USA.
Vet Hum Toxicol. 2001 Dec;43(6):342-4.
A 43-y-o male with a history of AIDS, atrial fibrillation, and alcohol abuse presented to the emergency department 2 h after ingestion of 25 tablets of 15 mg mirtazapine (total 375 mg) with ethanol in a suicide attempt (no other coingestion). Vital signs were normal except for a mild tachycardia (rate 112). Physical examination was unremarkable except for lethargy. Fifty grams of activated charcoal with sorbitol was given. Electrocardiogram showed sinus tachycardia, left ventricular hypertrophy, and non-specific ST-segment changes. Serum mirtazapine on admission was 530 ng/mL (therapeutic level 20-50 ng/mL). Overnight monitoring revealed no tachyarrythmias, and discharge occurred after psychiatric evaluation. It appears that ingestions of mirtazapine approximately 10-fold of therapeutic exhibit minimal acute toxicity. From this and other cases in the literature exhibiting a 10-fold overdose, we conclude that isolated mirtazapine ingestions of this magnitude require no acute intervention other than short term (about 6 h) observation.
一名43岁男性，有艾滋病、心房颤动和酗酒史，因企图自杀服用25片15毫克米氮平（共375毫克）并饮酒（无其他合并摄入）后2小时被送往急诊科。除轻度心动过速（心率112次/分）外，生命体征正常。体格检查除嗜睡外无异常。给予50克含山梨醇的活性炭。心电图显示窦性心动过速、左心室肥厚和非特异性ST段改变。入院时血清米氮平浓度为530纳克/毫升（治疗浓度为20 - 50纳克/毫升）。夜间监测未发现快速性心律失常，经精神科评估后出院。似乎摄入约为治疗剂量10倍的米氮平显示出最小的急性毒性。从该病例及文献中其他显示过量10倍的病例来看，我们得出结论，单纯摄入如此剂量的米氮平除短期（约6小时）观察外无需急性干预。
