ARDS ile sonuçlanan çoklu ilaç zehirlenmesi
Reçete edilen antidepresan ve antipsikotiklerin uygunsuz kullanımına bağlı kardiyak komplikasyonlar sık gözlenir ve ölüme yol açabilir. Akciğer komplikasyonları ise seyrektir. Ketiapin, karbamazepin ve klomipramin ile intihar girişimi sonucu akciğer ödemi ve oksijen tedavisine yanıtsız hipoksi gelişen akut respiratuar yetmezlikli bir olguyu sunduk. Recruitment manevraları ve akciğeri koruyucu ventilasyona rağmen, yoğun bakımdaki tedavisinin onuncu gününde septik şok ve çoklu organ yetmezliği nedeniyle kaybedildi. Literatür araştırmalarında, klomipramine bağlı alerjik akciğer ödemi tablosunun nadir olarak görülebildiği belirtilmektedir. Her üç ilacın da birbirinin serum seviyesini etkileyebildiği dikkate alındığında, tabloya üç ilacın sinerjistik etkisinin neden olduğu düşüncesindeyiz
Multiple drugs poisoning resulting in ARDS
Inappropriate use of prescribed antidepressants and antipsychotics may frequently cause death due to cardiac complications. Lung complications are rare. We present a case of acute respiratory distress syndrome due to suicide attempt with quetiapine, carbamazepine, and clomipramine. The patient developed pulmonary edema and hypoxemia refractory to oxygen treatment. The patient died due to septic shock and multi-organ failure at the tenth day of intensive care treatment, despite recruitment maneuvers and lung-protective ventilation. Cases of allergic lung edema due to clomipramine are very rare in the literature. When considering the fact that all three drugs may elevate serum concentrations of each other, we are in opinion that the sinergistic effect of three drugs may be the cause. J Clin Exp Invest 2014; 5 (3): 466-468
___
- Kekeç Z, Sözüer EM, Duymaz H, et al. Acil servise baş- vuran çoklu ilaç zehirlenmelerinin yedi yıllık analizi. Türkiye Acil Tıp Dergisi 2005;5:69-72.
- Hasnain M, Vieweq WV, Howland RH, et al. Quetiap- ine, QTc interval prolongation, and torsade de pointes: a review of case reports. Ther Adv Psychopharmacol 2014;4:130-138.
- Santana NO, Gois AF. Rhabdomyolysis as a manifes- tation of clomipramine poisoning. Sao Paulo Med J 2013;131:432-435.
- Patel VH, Schindlebeck MA, Bryant SM. Delayed el- evation in carbamazepine concentrations after over- dose: a retrospective poison center study. Am J Ther 2013;20:602-606.
- Sikma M, van den Broek MP, Meulenbelt J. Increased unbound drug fraction in acute carbamazepine intoxi- cation: suitability and effectiveness of high-flux hae- modialysis. Intensive Care Med 2012;38:916-917.
- Fanoe S, Kristensen D, Fink-Jensen A, et al. Risk of arrhythmia induced by psychotropic medications: a proposal for clinical management. Eur Heart J 2014;35:1306-1315.
- Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307:2526-2533.
- Şen A, Tomak Y, Erdivanlı B, Kurt A. Ketiapine bağlı ge- lişen kardiyak arrest ve bilinç kapanması. Turk Yogun Bakim Derg 2012;10:131-133.
- Trenton A, Currier G, Zwemer F. Fatalities associated with therapeutic use and overdose of atypical antipsy- chotics. CNS Drugs 2003;17:307-324.
- Soderstrom J, Murray L, Little M, et al. Toxicology case of the month: carbamazepine overdose. Emerg Med J 2006;23:869-871.
- Soriano FG, Vianna ES, Velasco IT. Neuroleptic in- duced acute respiratory distress syndrome. Sao Pau- lo Med J 2003;121:121-124.
- Li C, Gefter WB. Acute pulmonary oedema induced by overdosage of phenothiazines. Chest 1992;101:102-104.
- Savici D, Katzenstein AL. Diffuse alveolar damage and recurrent respiratory failure report of 6 cases. Hum Pathol 2001;32:1398-1402.
- Dale O, Hole A. Biphasic time-course of serum con- centrations of clomipramine and desmethylclomip- ramine after a near-fatal overdose. Vet Hum Toxicol 1994;36:309-310.
- Fuente JM, Mendlewicz J. Carbamazepine addition in tricyclic antidepressant-resistant unipolar depression. Biol Psychiatry 1992;32:369-374.
- Gerson GR, Jones RB, Luscombe DK. Studies on the concomitant use of carbamazepine and clomipramine for the relief of post-herpetic neuralgia. Postgrad Med J 1977;53:104-109.