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Fatal fluoxetine ingestion with postmortem blood concentrations
Russel Compton1, Henry A Spiller, George M Bosse
1Lewis-Gale Medical Center, Salem, Virginia, USA.
Clinical Toxicology (Philadelphia, Pa.)
|July 23, 2005
Summary
Massive fluoxetine (Prozac) overdose caused seizures and fatal cardiac events, including ventricular fibrillation and asystole. This case highlights severe toxicity from a large fluoxetine ingestion.
Area of Science:
- Clinical Toxicology
- Cardiology
- Neurology
Background:
- Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine are widely prescribed.
- Overdose cases are typically managed for central nervous system effects.
- Cardiovascular complications are less commonly emphasized in fluoxetine toxicity.
Observation:
- A 37-year-old male presented after ingesting 12 grams of fluoxetine.
- The patient experienced tonic-clonic seizures, successfully treated with benzodiazepines.
- Subsequent development of severe bradycardia, ventricular fibrillation, and asystole occurred.
Findings:
- Postmortem toxicology confirmed a high fluoxetine level (4500 mcg/L).
- Elevated diazepam levels (500 mcg/L) were also detected.
- The combined effects led to fatal cardiovascular collapse.
Implications:
- Massive fluoxetine ingestion can precipitate life-threatening cardiac arrhythmias.
- This case underscores the critical need for cardiac monitoring in severe SSRI overdose.
- Understanding dose-dependent toxicity is crucial for emergency management of fluoxetine poisoning.