A Case of Trazodone Overdose Successfully Rescued With Lipid Emulsion Therapy.

Joshua Burg,Roger Taylor,Jeff Mullen

doi:10.7759/cureus.10864

Abstract

Trazodone is a very common medication prescribed to patients who suffer from insomnia. The toxic effects of trazodone remain ill-defined with no current known antidote therapy. Lipid emulsion therapy has been described as general rescue therapy in toxicology. Unfortunately, only select substance overdoses respond to lipid emulsion therapy. The authors present a unique application of lipid emulsion therapy in a post-cardiac arrest situation involving a trazodone overdose.

Highlights

Overdoses of medications and various substances occur daily in emergency departments worldwide
The patient's past medical history was significant for anxiety, depression, coronary artery disease (CAD), congestive heart failure (CHF) with a known left ventricular ejection fraction (LVEF) of 45-50%, chronic obstructive pulmonary disease (COPD), diabetes type II, and tobacco use
Lipid emulsion therapy is routinely not recommended in trazodone overdoses

Summary

Introduction

Overdoses of medications and various substances occur daily in emergency departments worldwide. Several toxic overdoses encountered in toxicology and emergency medicine do not have immediate reversal antidotes The patient had reported taking twenty trazodone 100 mg tablets three hours before arrival He denied any other coingestants, including alcohol and other illicit drugs. The patient's past medical history was significant for anxiety, depression, coronary artery disease (CAD), congestive heart failure (CHF) with a known left ventricular ejection fraction (LVEF) of 45-50%, chronic obstructive pulmonary disease (COPD), diabetes type II, and tobacco use. After considering possible sodium channel blockade effect, prolonged QTc, and newly widened QRS complexes, a total of sodium bicarbonate 350 mEq was given as IV pushes. An immediate post-ROSC EKG revealed a prolonged QTC of 539 with widened QRS of 192 (Figure 2). The patient was deemed psychiatrically stable for discharge after a 10-day admission

Discussion

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Disclosures

Tintinalli J