Balit Corrine R, Isbister Geoffrey K, Hackett L Peter, Whyte Ian M
New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia.
Ann Emerg Med. 2003 Dec;42(6):751-8. doi: 10.1016/s0196-0644(03)00600-0.
We describe the effects of quetiapine in overdose.
Quetiapine poisonings were identified from a prospective database of poisoning admissions to a regional toxicology service. Data extracted included details of ingestion, clinical features, investigations (including ECG), and other outcomes (length of stay and ICU admission rate).
There were 45 cases of quetiapine overdose, of which 18 patients with quetiapine assay results were included. Median length of stay was 35 hours (interquartile range [IQR] 14 to 42 hours) for the 18 patients, and 9 were admitted to the ICU. The median ingested dose was 3.5 g (IQR 1.7 to 6.2 g), and reported ingested dose was highly correlated with estimated peak drug concentration (r(2)=0.84; P<.0001), confirming patient-provided history of ingestion. Seizures occurred in 2 patients, delirium occurred in 3 patients, and mechanical ventilation was required in 4 patients. No arrhythmias or deaths occurred. Six of the 18 patients ingested quetiapine alone, with a median length of stay of 35 hours, and 3 were admitted to the ICU. In 1 patient who ingested 24 g, hypotension and seizures occurred. For 10 patients for whom ECGs were available and who had ingested no cardiotoxic drugs, tachycardia occurred in 8 patients. For these 10 patients, the mean corrected QT (QTc) interval was increased at 487 ms, but the mean uncorrected QT interval was 349 ms. Reported dose and peak quetiapine concentrations were significantly associated with ICU admission and length of stay more than 24 hours. A reported dose less than 3 g and a Glasgow Coma Scale score not less than 15 predicted patients not requiring ICU admission or length of stay more than 24 hours.
Quetiapine overdose causes central nervous system depression and sinus tachycardia. In large overdoses, patients may require intubation and ventilation for associated respiratory depression. Although a prolonged QTc occurs, its clinical significance is unclear because it is most likely caused by an overcorrection caused by the tachycardia. In our experience, a reported dose of less than 3 g for patients who are not drowsy (with a Glasgow Coma Scale score of 15) at least 4 hours after ingestion and who did not coingest another toxic agent defined a group not requiring ICU admission or inpatient admission greater than 24 hours.
我们描述了喹硫平过量服用的影响。
从一个区域毒理学服务机构的中毒入院前瞻性数据库中识别出喹硫平中毒病例。提取的数据包括摄入详情、临床特征、检查（包括心电图）以及其他结果（住院时间和重症监护病房入住率）。
有45例喹硫平过量服用病例，其中18例有喹硫平检测结果的患者被纳入研究。这18例患者的中位住院时间为35小时（四分位间距[IQR]为14至42小时），9例入住重症监护病房。中位摄入剂量为3.5克（IQR为1.7至6.2克），报告的摄入剂量与估计的药物峰值浓度高度相关（r² = 0.84；P <.0001），证实了患者提供的摄入史。2例患者发生癫痫，3例患者出现谵妄，4例患者需要机械通气。未发生心律失常或死亡。18例患者中有6例单独服用喹硫平，中位住院时间为35小时，3例入住重症监护病房。1例摄入24克的患者出现低血压和癫痫。对于10例有心电图且未摄入心脏毒性药物的患者，8例出现心动过速。对于这10例患者，平均校正QT（QTc）间期增加至487毫秒，但平均未校正QT间期为349毫秒。报告的剂量和喹硫平峰值浓度与重症监护病房入住以及住院时间超过24小时显著相关。报告剂量小于3克且格拉斯哥昏迷量表评分不少于15分可预测患者不需要入住重症监护病房或住院时间超过24小时。
喹硫平过量服用会导致中枢神经系统抑制和窦性心动过速。在大量过量服用时，患者可能因相关的呼吸抑制而需要插管和通气。尽管QTc间期延长，但其临床意义尚不清楚，因为这很可能是由心动过速导致的过度校正引起的。根据我们的经验，对于摄入后至少4小时不困倦（格拉斯哥昏迷量表评分为15分）且未同时摄入其他有毒物质的患者，报告剂量小于3克可确定为不需要入住重症监护病房或住院时间超过24小时的一组患者。
