Warstadt Nicholus M, Mohan Sanjay, Furlano Emma R, Shenker Jennifer H, Gibbs Eric P, Smith Silas W
New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York.
New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, Division of Medical Toxicology, New York, New York.
Clin Pract Cases Emerg Med. 2022 Feb;6(1):32-36. doi: 10.5811/cpcem.2021.10.54520.
Aripiprazole is an atypical antipsychotic with unique receptor-binding properties that has a favorable safety profile in therapeutic doses compared to other antipsychotics. Massive aripiprazole overdose in children, however, presents with profound lethargy and may have neurologic, hemodynamic, and cardiac effects, often requiring admission to a high level of care.
We describe a case of a 21-month-old male with a reported 52-milligram aripiprazole ingestion. Initial vital signs were remarkable for tachycardia and hypertension, which rapidly resolved. The patient did not develop hypotension throughout hospitalization. He experienced 60 hours of lethargy. Irritability associated with upper extremity spasms and tremors occurred from 36-72 hours post ingestion, which resolved without intervention. The initial electrocardiogram demonstrated ST-segment depressions in the anteroseptal leads; further cardiac workup was normal. Concurrent medical workup was unrevealing. Aripiprazole and dehydro-aripiprazole serum concentrations sent 46 hours after reported exposure were 266.5 nanograms per milliliter (ng/mL) and 138.6 ng/mL, respectively. He returned to neurologic baseline and was discharged 72 hours after ingestion.
Antipsychotics, including aripiprazole, should be considered as a potential toxicological cause of persistent central nervous system depression; ingestion of a single dose has the potential to cause significant toxicity.
阿立哌唑是一种具有独特受体结合特性的非典型抗精神病药物，与其他抗精神病药物相比，在治疗剂量下具有良好的安全性。然而，儿童大量服用阿立哌唑会出现深度嗜睡，并可能产生神经、血液动力学和心脏方面的影响，通常需要入住高级护理病房。
我们描述了一名21个月大的男性病例，据报告其摄入了52毫克阿立哌唑。初始生命体征以心动过速和高血压为显著特征，这些症状迅速缓解。患者在整个住院期间未出现低血压。他经历了60小时的嗜睡。摄入后36至72小时出现与上肢痉挛和震颤相关的易激惹，未经干预即自行缓解。初始心电图显示前间隔导联ST段压低；进一步的心脏检查正常。同时进行的医学检查未发现异常。报告暴露后46小时测得的阿立哌唑和脱氢阿立哌唑血清浓度分别为266.5纳克/毫升（ng/mL）和138.6 ng/mL。他恢复到神经学基线水平，摄入后72小时出院。
包括阿立哌唑在内的抗精神病药物应被视为持续性中枢神经系统抑制的潜在毒理学原因；单次摄入有可能导致显著毒性。
