Department of Anesthesia and Intensive Care Medicine, Södra Älvsborg Hospital, Borås, Sweden.
Clin Toxicol (Phila). 2013 Jul;51(6):501-4. doi: 10.3109/15563650.2013.803229. Epub 2013 Jun 14.
Quetiapine is an atypical antipsychotic medication that is increasingly being used in the treatment of psychotic disorders and depression. An overdose of quetiapine is associated with hypotension, sinus tachycardia, and sedation. The clinical effects of its overdose are often mild to moderate, but a severe overdose can cause cardiovascular collapse and death.Intravenous lipid emulsion (ILE) is a proposed treatment for potentially lethal cardiotoxicity after severe overdoses with lipophilic drugs, such as quetiapine, mainly by the sequestration of the lipophilic toxin to an expanded intravascular lipid phase.
To report a case where ILE was successfully used in the resuscitation of a patient with cardiovascular collapse after a severe quetiapine overdose.
A 42-year-old woman was admitted to the Emergency Department after being found unconscious at home, due to an estimated ingestion of 24 g of quetiapine (Seroquel). She was initially cardiorespiratory stable and unresponsive with a Glasgow Coma Scale of 3. The woman was immediately admitted to the Intensive Care Unit, where her condition quickly deteriorated. She was intubated, due to loss of airway. In addition, a gastric lavage was performed and activated charcoal was administered. The patient presented with cardiovascular collapse refractory to vasopressor treatment and volume resuscitation. ILE bolus followed by continuous infusion was administered. Her blood pressure started increasing 5 min after ILE was initiated and within an hour circulation was stabilized. The patient recovered completely without any residual symptoms, after 3 days in the ICU.
ILE may potentially be life-saving in cases of severe quetiapine poisoning and should be considered as a treatment for severe cardiovascular instability resulting from quetiapine poisoning refractory to maximum conventional therapy.
喹硫平是一种非典型抗精神病药物，越来越多地用于治疗精神障碍和抑郁症。喹硫平过量与低血压、窦性心动过速和镇静有关。其过量的临床影响通常为轻度至中度，但严重过量可导致心血管崩溃和死亡。静脉内脂肪乳剂（ILE）是一种治疗亲脂性药物（如喹硫平）严重过量引起的潜在致命性心脏毒性的方法，主要通过将亲脂性毒素隔离到扩展的血管内脂肪相中。
报告一例 ILE 成功用于抢救严重喹硫平过量后心血管崩溃的患者。
一名 42 岁女性因在家中被发现昏迷而被送入急诊科，据估计摄入了 24 克喹硫平（Seroquel）。她最初心肺功能稳定且无反应，格拉斯哥昏迷量表评分为 3 分。该女性立即被收入重症监护病房，她的病情迅速恶化。她因气道丧失而被插管。此外，还进行了胃灌洗和给予活性炭。患者出现对血管加压药物和容量复苏治疗无反应的心血管崩溃。给予 ILE 推注，然后连续输注。ILE 开始后 5 分钟，她的血压开始升高，1 小时内循环稳定。患者在重症监护病房 3 天后完全康复，没有任何残留症状。
ILE 可能对严重喹硫平中毒有潜在的救命作用，应考虑作为治疗严重心血管不稳定的方法，这种不稳定是由对最大常规治疗无反应的喹硫平中毒引起的。
