Abstract
BackgroundSevere venlafaxine intoxication may cause arrhythmias, cardiac failure, and even cardiac arrest.Case presentationA 48-year-old caucasian male with an extensive psychiatric history ingested a high dose of venlafaxine causing a serum venlafaxine concentration of 12.6 mg/L 24 hours after ingestion. Seven hours post-ingestion, he experienced tonic–clonic seizures, and 8 hours later, takotsubo cardiomyopathy was recognized followed by cardiac arrest. The patient was resuscitated with prolonged cardiopulmonary resuscitation including ongoing automatic external compressions during helicopter transportation to a tertiary hospital for extracorporeal membrane oxygenation treatment. Despite a cardiopulmonary resuscitation duration of 2 hours, 36 hours of extracorporeal membrane oxygenation, and a total of 30 days of intensive care, the patient made a full recovery.ConclusionIn cases of intoxication-induced cardiac arrests among otherwise young and healthy patients, prolonged cardiopulmonary resuscitation and extracorporeal circulation can be a life-saving bridge to recovery.
Highlights
Severe venlafaxine intoxication may cause arrhythmias, cardiac failure, and even cardiac arrest.Case presentation: A 48-year-old caucasian male with an extensive psychiatric history ingested a high dose of venlafaxine causing a serum venlafaxine concentration of 12.6 mg/L 24 hours after ingestion
Case presentation A 48-year-old caucasian male with an extensive psychiatric history of depression was admitted to the intensive care unit at a local hospital following intoxication of approximately 20 g venlafaxine, 450 mg zolpidem, and 250 mg propiomazine
One hour 15 minutes after the cardiac arrest, the patient was delivered to the tertiary hospital for Extracorporeal membrane oxygenation (ECMO) initiation
Summary
The antidepressant venlafaxine is a serotonin, a norepinephrine, and to some extent a dopamine reuptake inhibitor. Case presentation A 48-year-old caucasian male with an extensive psychiatric history of depression was admitted to the intensive care unit at a local hospital following intoxication of approximately 20 g venlafaxine, 450 mg zolpidem, and 250 mg propiomazine. One hour 15 minutes after the cardiac arrest, the patient was delivered to the tertiary hospital for ECMO initiation. The amount of epinephrine was significantly decreased during the initial hours of ECMO treatment, and norepinephrine and milrinone were used instead. The patient was transported back to the primary hospital with decreasing doses of norepinephrine the day after ECMO termination. The patient’s renal function was fully restored with normal creatinine level (82 μmol/L) 7 weeks after the intoxication He was discharged in good health without his former prescribed psychiatric medications. The serum venlafaxine concentration 24 hours after ingestion was 12.6 mg/L, but this laboratory result was not received until 1 week after ingestion
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