Ballesteros Salomé, Martínez María A, Ballesteros M Angeles, de la Torre Carolina Sánchez, Rodríguez-Borregán Juan C
Spanish Poison Control Centre, National Institute of Toxicology and Forensic Sciences, Ministry of Justice, Madrid, Spain.
Clin Toxicol (Phila). 2007 May;45(4):412-5. doi: 10.1080/15563650601072183.
Olanzapine is a second-generation atypical antipsychotic agent approved for the treatment of psychotic disorders and mania. While olanzapine overdoses are common, cases with whole blood concentrations are less so. We describe here a well-documented case of a pure olanzapine overdose in which whole blood concentrations were determined, and compared with other concentrations in the literature.
A 58-year-old woman with a 10-year history of paranoid schizophrenia and poor therapeutic compliance was found unconscious with two empty 28-tablet vials of Zyprexa (olanzapine) 10 mg tablets. Her initial vital signs were blood pressure 110/70 mmHg, pulse rate 82 beats/minute (sinus rhythm), respirations 20 breaths/minute, and the Glasgow Coma Scale score was 7. In the Intensive Care Unit, her pulse rate was 160 beats/minute, in sinus rhythm, and QTc 0.423 seconds (normal <0.4 seconds). Relevant analytical findings were metabolic acidosis, leukocytosis, creatine phosphokinase 1992 mg/dL, and glucose 207 mg/dL. Ten hours after being found, her blood sugar was 350 mg/dL and became normal at 25 hours. The patient needed intubation and insulin.
Olanzapine was detected and quantitated by gas chromatography with nitrogen-phosphorus detector and confirmed by gas chromatography-mass spectrometry using a validated analytical method. At approximately 4, 8, and 12 hours post-ingestion, whole blood concentrations of olanzapine were 0.41, 0.34, and 0.38 mg/L, respectively.
This study reports an acute olanzapine monointoxication with severe toxicity and high whole blood olanzapine concentrations. Clinical and analytical data of similar samples obtained in non-fatal life-threatening cases can be very useful when interpreting postmortem cases.
奥氮平是一种第二代非典型抗精神病药物，被批准用于治疗精神障碍和躁狂症。虽然奥氮平过量服用很常见，但测定全血浓度的病例较少。我们在此描述一例记录完整的单纯奥氮平过量服用病例，其中测定了全血浓度，并与文献中的其他浓度进行了比较。
一名58岁女性，有10年偏执型精神分裂症病史且治疗依从性差，被发现昏迷，身旁有两瓶空的28片装的再普乐（奥氮平）10毫克片剂。她最初的生命体征为血压110/70毫米汞柱，脉搏率82次/分钟（窦性心律），呼吸频率20次/分钟，格拉斯哥昏迷量表评分为7分。在重症监护病房，她的脉搏率为160次/分钟，窦性心律，QTc为0.423秒（正常<0.4秒）。相关分析结果为代谢性酸中毒、白细胞增多、肌酸磷酸激酶1992毫克/分升和血糖207毫克/分升。被发现10小时后，她的血糖为350毫克/分升，25小时后恢复正常。患者需要插管和胰岛素治疗。
采用氮磷检测器气相色谱法检测并定量奥氮平，并用经过验证的分析方法通过气相色谱 - 质谱法进行确认。摄入后约4、8和12小时，奥氮平的全血浓度分别为0.41、0.34和0.38毫克/升。
本研究报告了一例急性奥氮平单一中毒病例，具有严重毒性和较高的全血奥氮平浓度。在解释死后病例时，非致命性危及生命病例中获得的类似样本的临床和分析数据可能非常有用。
