Citation

Monterrubio Villar J, Córdoba López A. Med. Intensiva 2007; 31(6): 343-344.

Copyright

(Copyright © 2007, Elsevier Publishing)

DOI

10.1016/S0210-5691(07)74835-0

PMID

unavailable

Abstract

Indications:1 patient with reactive depression. Coexisting diseases: type 2 diabetes mellitus, dyslipidemia, brain hemorrhage, and pelvic trauma.; Patients:One 63-year-old female inpatient (dropped out due to side effects).; TypeofStudy:A case report describing serotonin syndrome (SS) after the administration of a single tablet of Anafranil in a critically ill patient with reactive depression who had recent episodes of neuroleptic malignant syndrome. Letters to the editor.; DosageDuration:75 mg enterally as tablet formulation (single dose).; Results:A few hours after Anafranil administration, the patient developed SS characterized by fever of 39 °C, myoclonus, chills, sinus tachycardia up to 130 bpm, and arterial hypertension (220/100 mmHg). Laboratory tests showed elevated levels of LDH up to 864 UI/l, aspartate aminotransferase (39-60 U/l), alanine aminotransferase (269-434 U/l), troponin I (0-55 ng/ml), CK-MB (3-4 ng/ml), and D-dimer (up to 6.538 ng/ml) and prolongation of prothrombin time (16 seconds). Anafranil was discontinued and parenteral treatment for fever , diazepam, and sublingual nitroglycerin were given which resulted to improvement of symptoms with disappearance of fever and myoclonus.; AdverseEffects:1 patient developed serotonin syndrome characterized by fever, myoclonus, chills, sinus tachycardia, hyperthermia, arterial hypertension, and elevated levels of LDH, aspartate aminotransferase, alanine aminotransferase, troponin I, CK-MB, D-dimer, and lengthening prothrombin time.; AuthorsConclusions:In addition to the withdrawal of the offending drug and the usual supportive measures provided in the intensive care unit, we employed sublingual nitroglycerin with good results, which has been published before elsewhere.; FreeText:The patient was admitted after a suicide attempt. Previous therapy included venlafaxine, mirtazapine, risperidone, and lorazepam. She was treated with intravenous haloperidol and risperidone, however, she developed neuroleptic malignant syndrome. Treatment with bromocriptine and dantrolene resulted to improvement and recovery in the following weeks. Anafranil was then initiated for depression reactive to her long hospital stay. Concomitant medications: insulin for type 2 diabetes mellitus. Tests: heart rate, blood pressure, lactate dehydrogenase (LDH), aspartate aminotransferase, alanine aminotransferase, troponin I, creatine kinase MB (CK-MB), D-dimer, and prothrombin time.

Language: es

Keywords

adult; human; female; case report; traumatic brain injury; treatment outcome; neuroimaging; serotonin release; clinical feature; clomipramine; mirtazapine; monoamine oxidase inhibitor; pathophysiology; serotonin uptake inhibitor; tricyclic antidepressant agent; venlafaxine; letter; diazepam; haloperidol; neurotransmission; risperidone; laboratory diagnosis; lorazepam; computer assisted tomography; serotonin syndrome; clinical examination; hemofiltration; monotherapy; dopamine receptor blocking agent; clinical assessment