Lipid therapy for serotonin syndrome after intoxication with venlafaxine, lamotrigine and diazepam

A 44-year-old woman developed coma and seizure activity after intentional ingestion of 200 mg diazepam, 20 g lamotrigine and 4.5 g venlafaxine. In our intensive care unit a distinct rigidity and hyperreflexia was observed. This status was not influenced by haemodialysis which was initiated directly after admission. Plasma concentrations of the ingested drugs were determined before hemodialysis was started (560 µg/L diazepam, 42.4 mg/L lamotrigine and 1254 µg/L venlafaxine). Eight hours after the start of haemodialysis a 150 mL (2.5 mL/kg) intravenous bolus of 20% lipid emulsion was given. Soon after administration of the lipid infusion the distinct rigidity and hyperreflexia disappeared. The further course was uneventful.