Prolonged delirium after quetiapine overdose
Sean Hyun Rhyee1, Ernest Vijay Pedapati, Jennifer Thompson
1Division of Medical Toxicology, University of Massachusetts Medical School, Worcester, MA, USA. rhyees@umassmemorial.org
Pediatric Emergency Care
|October 9, 2010
Summary
This case study highlights a 15-year-old experiencing prolonged delirium after an overdose of quetiapine and other medications. Physostigmine provided temporary symptom relief, suggesting quetiapine
Area of Science:
- Pharmacology
- Pediatric Toxicology
- Neuroscience
Background:
- Quetiapine, an atypical antipsychotic, is increasingly prescribed for pediatric schizophrenia and bipolar disorder.
- Limited data exist on quetiapine's effects in pediatric overdose scenarios.
Observation:
- A 15-year-old presented with sedation after a quetiapine, trazodone, and clonidine overdose.
- Delirium and increased heart rate emerged on day 3, persisting for 5 days post-ingestion.
- High serum quetiapine levels were recorded (3400 ng/mL at 1 day, 4800 ng/mL at 5 days).
Findings:
- Quetiapine-associated antimuscarinic toxicity was suspected as the cause of persistent delirium.
- Intravenous physostigmine administration led to transient symptom resolution.
Implications:
- This case underscores the potential for prolonged anticholinergic toxicity from quetiapine overdose in adolescents.
- Physostigmine may be a useful antidote for managing severe quetiapine-induced antimuscarinic effects.
- Further research is needed to understand quetiapine's toxicokinetics and management in pediatric overdose.
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