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Pediatric ziprasidone overdose
Charles J Fasano1, Gerald F O'Malley, Claudia Lares
1Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA. pasanoc@einstein.edu
Pediatric Emergency Care
|April 17, 2009
Summary
A pediatric ziprasidone overdose case highlights that even one pill can cause severe respiratory depression and altered mental status in children. Pinpoint pupils unresponsive to naloxone were noted, a rare symptom in ziprasidone toxicity.
Area of Science:
- Pharmacology
- Pediatric Toxicology
Background:
- Ziprasidone is an atypical antipsychotic approved for schizophrenia in adults.
- Pediatric ziprasidone overdose literature previously described sedation, tachycardia, hypotonia, and coma.
Observation:
- A 30-month-old child experienced lethargy and unresponsiveness after ingesting at least one ziprasidone tablet.
- The patient developed pinpoint pupils unresponsive to naloxone, along with profound mental status and respiratory depression.
- Treatment included naloxone, intubation, and activated charcoal for gastrointestinal decontamination.
Findings:
- This case presents the first quantitative serum levels of ziprasidone in a pediatric overdose.
- The observed symptoms, including coma and respiratory depression, align with known pediatric ziprasidone overdose profiles.
- The development of pinpoint pupils unresponsive to naloxone is a notable finding, potentially linked to alpha-1 receptor blockade.
Implications:
- This case underscores the potential for severe toxicity in pediatric ziprasidone ingestion, even with small amounts.
- The unresponsive miosis suggests a specific mechanism related to atypical antipsychotic overdose.
- Further research into the mechanisms of atypical antipsychotic-induced miosis is warranted.
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