Prolonged delirium after quetiapine overdose
Department of Pediatrics; Department of Emergency Medicine
Medical Subject Headings
Adolescent; Antipsychotic Agents; dosage; Cholinergic Antagonists; dosage; Clonidine; Cytochrome P-450 CYP3A; Delirium; Depression; Dibenzothiazepines; dosage; Drug Interactions; Emergencies; Female; Heart Block; Humans; Hypotension; Physostigmine; Self-Injurious Behavior; Suicide, Attempted; Tachycardia; Time Factors; Trazodone
Emergency Medicine | Pediatrics
Quetiapine is an atypical antipsychotic agent increasingly used to treat schizophrenia and bipolar disorder in pediatric patients. Few published data exist concerning quetiapine's effects in therapeutic settings or short-term overdose in pediatric and adolescent populations. In this report, we describe a 15-year-old adolescent girl who experienced continued delirium 5 days after an overdose of quetiapine, trazodone, and clonidine. The patient initially presented with sedation and stable vital signs. After 3 days of gradual improvement, she experienced episodes of delirium coinciding with an increase in resting heart rate. On the basis of suspicion for quetiapine-associated antimuscarinic effects, the patient was administered intravenously with physostigmine on the fifth day after ingestion. Treatment resulted in a brief resolution of symptoms. Serum quetiapine levels measured 1 day and 5 days after ingestion were 3400 and 4800 ng/mL, respectively. The use of physostigmine and interpretation of serum levels are discussed further.
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Citation: Pediatr Emerg Care. 2010 Oct;26(10):754-6. Link to article on publisher's site