Abstract
Venous thromboembolism is a very common pathological process for which there are many well known (and less well-known) predisposing factors. Likewise, olanzapine is a commonly used anti-psychotic medication.We present the case of a young Somali gentleman who developed venous thromboembolic disease after an overdose of olanzapine. The diagnosis was only made 48 hours after admission, due to the non-specific presentation of the pulmonary embolus and the fact that the link between olanzapine and pulmonary embolus was not previously widely described and therefore it did not immediately figure in the differential diagnosis. The patient made a full recovery.There is an increasing body of circumstantial evidence linking olanzapine to pulmonary embolus. Clinicians should bear this possible association in mind when prescribing the drug and when faced with clinical situations where venous thromboembolism (VTE) is a possible diagnosis. VTE has occasionally been described in therapeutic dose olanzapine therapy, but never in the context of an acute overdose. Khat, a recreational drug, has been linked to arterial, but not venous thrombosis.It is hoped that this case report will further encourage research into these associations, which remain to be proven and quantified.In the context of changing population demographics and increasing global migration, a greater awareness of the potential effects of endemic practices and their potential consequences is essential to the modern-day doctor working in a multi-cultural society.
Highlights
Olanzapine is an atypical anti-psychotic, very commonly used in the management of schizophrenia and mania
We describe an interesting case of massive pulmonary embolism temporally related to ingestion of an olanzapine overdose and explore the existing literature on the topic
There have been few case reports and case-control studies to support an association between atypical anti-psychotics and venous thromboembolism (VTE) and these are mainly related to clozapine
Summary
Olanzapine is an atypical anti-psychotic, very commonly used in the management of schizophrenia and mania. Case Presentation A 27-year old, obese Somali gentleman was admitted with a history of acute onset of hallucinations and delirious behaviour He was found by his relatives with suspected olanzapine overdose and had been on the floor for more than two days. The patient had a longstanding history of “Khat” abuse (a flowering plant with amphetamine-like effects) On admission, he was noted to be disorientated and confused. Following medical treatment for the pulmonary embolus and lower respiratory tract infection, he was discharged to the care of the mental health team.
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