Intravenous lipid emulsion as rescue therapy in severe quetiapine overdose: A case report

Severe quetiapine overdose may lead to central nervous system depression and cardiovascular instability; however, refractory distributive shock is an uncommon and life-threatening presentation. Intravenous lipid emulsion has emerged as a potential adjunctive therapy in intoxications caused by highly lipophilic drugs, although evidence remains limited. We report the case of a 25-year-old woman with intentional ingestion of approximately 4.5 g of quetiapine, who developed progressive neurological deterioration and refractory distributive shock despite mechanical ventilation and dual vasopressor support. Laboratory findings showed severe metabolic acidosis with hyperlactataemia, and echocardiography revealed a hyperdynamic profile with reduced systemic vascular resistance. Given the persistence of haemodynamic instability and neurological impairment, a 20% intravenous lipid emulsion was administered as rescue therapy. Within three hours, the patient exhibited marked neurological improvement, with recovery of consciousness (Glasgow Coma Scale score 14/15), along with progressive haemodynamic stabilization allowing discontinuation of vasopressors. Lactate levels normalized within 9 h, and the patient was successfully extubated at 24 h, with no treatment-related adverse events. This case highlights the potential role of intravenous lipid emulsion as an adjunctive rescue therapy in severe quetiapine intoxication with refractory haemodynamic and neurological compromise. Although causality cannot be definitively established, the temporal association and rapid clinical response support its consideration when conventional supportive measures are insufficient.