Weizberg M, Su M, Mazzola J L, Bird S B, Brush D E, Boyer E W
Department of Emergency Medicine, SUNY Downstate Medical Center/Kings County Hospital, Brooklyn, NY 11203, USA.
Clin Toxicol (Phila). 2006;44(3):319-25. doi: 10.1080/15563650600584535.
Olanzapine is commonly prescribed to patients with schizophrenia. One retrospective study demonstrates the efficacy of physostigmine in reversing mental status changes induced by olanzapine. We report two patients with delirium due to confirmed olanzapine overdose treated with physostigmine. One patient's mental status transiently returned to normal. The other patient completely recovered. CASE 1: A 25-year-old man ingested 300 mg of olanzapine. On presentation, he was agitated, delirious, tachycardic, had dry skin and mucous membranes, and dilated pupils (6 mm) minimally reactive to light. Physostigmine, 0.5 mg, was given intravenously (IV) without effect. Additional physostigmine doses of 1.5 mg IV administered 5 minutes later and then 1 mg IV resulted in the patient having a clear sensorium and normal mentation. The patient's mental status continued to remain normal for the duration of his hospital stay. Olanzapine was identified in the urine by high performance liquid chromatography. CASE 2: A 20-year-old female ingested 600 mg of olanzapine. On presentation, she was tachycardic, obtunded, and minimally responsive to painful stimuli, with decreased bowel sounds, dry skin and dry mucous membranes. Physostigmine, 2 mg, was given IV. Shortly thereafter she regained full consciousness and began speaking coherently. She remained in this condition for approximately 30 minutes, and then became obtunded. Her serum olanzapine concentration was 1230 ng/mL. No further doses of physostigmine were administered. On day 3 of admission her mental status returned to normal.
We report two cases of olanzapine-induced mental status changes treated with physostigmine. The utility of physostigmine as a safe or necessary antidote in the setting of olanzapine overdose remains to be determined.
奥氮平常用于精神分裂症患者。一项回顾性研究证明了毒扁豆碱在逆转奥氮平所致精神状态改变方面的疗效。我们报告了两例确诊为奥氮平过量导致谵妄的患者，接受了毒扁豆碱治疗。其中一名患者的精神状态短暂恢复正常。另一名患者完全康复。病例1：一名25岁男性摄入了300毫克奥氮平。就诊时，他烦躁不安、神志不清、心动过速，皮肤和黏膜干燥，瞳孔散大（6毫米），对光反应微弱。静脉注射0.5毫克毒扁豆碱无效。5分钟后静脉追加1.5毫克毒扁豆碱，随后再静脉注射1毫克，患者意识清醒，思维正常。在其住院期间，精神状态持续保持正常。通过高效液相色谱法在尿液中检测到了奥氮平。病例2：一名20岁女性摄入了600毫克奥氮平。就诊时，她心动过速、意识模糊，对疼痛刺激反应微弱，肠鸣音减弱，皮肤和黏膜干燥。静脉注射2毫克毒扁豆碱。此后不久，她完全恢复意识并开始连贯说话。这种状态持续了约30分钟，然后又变得意识模糊。她的血清奥氮平浓度为1230纳克/毫升。未再追加毒扁豆碱剂量。入院第3天，她的精神状态恢复正常。
我们报告了两例用毒扁豆碱治疗奥氮平所致精神状态改变的病例。毒扁豆碱作为奥氮平过量时安全或必要的解毒剂的效用仍有待确定。
