Naslov
FATAL INTOXICATION WITH QUETIAPINE AND NITRAZEPAM

Autori
Mandić, Sanja ; Pavošević, Tihana ; Šahinović, Ines ; Horvat, Vesna ; Mandić, Dario ; Lukić, Iva ; Šerić, Vatroslav

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, ostalo

Izvornik
Clinical Chemistry and Laboratory Medicine / - , 2015, S1436-s1436

Skup
21st IFCC-EFLM European Congress of Clinical Chemistry and Laboratory Medicine

Mjesto i datum
Pariz, Francuska, 21.06.2015. - 25.06.2015

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
intoxication, quetiapine, nitrazepam

Sažetak
BACKGROUND-AIM Quetiapine is an antipsychotic drug used for the treatment of psychotic disorders. Nitrazepam is a benzodiazepine with sedative action. Both drugs are widely prescribed since they have been reported as relatively safe in overdose. This case report presents a fatal intoxication with Quetiapine and Nitrazepam. 53- year old man was admitted to the intensive care unit after taking unknown drugs in an attempted suicide. He was unconscious, febrile and hypotonic but without alterations in electrocardiogram. He was prescribed Quetiapine and Nitrazepam as regular therapy due to his medical history of posttraumatic stress disorder. METHODS Beside other laboratory analysis, drug screening was performed (VivaE ; Siemens). Confirmation analyses were performed using gas chromatography-mass spectrometry (GCMS–QP2010 Ultra ; Shimadzu) after liquid-liquid extraction. Finally, drug concentrations were measured by liquid chromatography-tandem mass spectrometry (LCMS/ MS –8040 ; Shimadzu). RESULTS Laboratory data on the day of admission revealed extremely high creatine kinase, myoglobin and D- dimmers, compensatory respiratory acidosis, hyperglycemia, the presence of alcohol and elevated liver enzymes with no evidence of kidney failure. Drug screen was positive for benzodiazepines and tricyclic antidepressant while confirmatory method with GCMS established presence of Quetiapine and Nitrazepam. Measured concentrations were 3.92 mg/L and 1.06 mg/L , respectively. The patient was extremely hemodynamically unstable and received high dose of noradrenaline. Because of consequently renal failure development he was dialyzed on the ninth day but despite that he arrested 10 days after admission. CONCLUSION Almost all laboratory results were in accordance with the findings disclosed in the literature after overdose with Quetiapine and Nitrazepam. Although drug concentrations were below lethal values described in the literature, their synergistic action together with alcohol led to lethal outcome. Both drugs cause central nervous system depression which may result in coma with possible fatal outcome as shown in this case.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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