1/7. suicide attempt by pure citalopram overdose causing long-lasting severe sinus bradycardia, hypotension and syncopes: successful therapy with a temporary pacemaker.In few cases, pure citalopram overdose at doses above 600 mg showed electro-cardiographic changes with prolonged QT intervals and sinus bradycardia gradually resolving within 12-24 hours after intoxication. We report on a 32-year-old patient with borderline personality disorder (BPD) who ingested a total of 800 mg citalopram to attempt suicide due to an interpersonal disappointment. She developed severe sinus bradycardia with a minimal pulse rate of 41/min within about 4 hours after intoxication lasting up to six days during intensive care unit (ICU) treatment. Further, hypotension and syncopes occurred. No QT interval prolongations were recorded. To our knowledge, this is the first case report of pure citalopram overdose-induced long-lasting sinus bradycardia associated with severe hypotension and intermittent syncopes that required therapy with a temporary pacemaker.- - - - - - - - - - ranking = 1keywords = suicide (Clic here for more details about this article) |
2/7. Intoxication with taxus baccata: cardiac arrhythmias following yew leaves ingestion.The use of yew leaves (taxus Baccata) as a means of deliberate self-harm is infrequent. The potent effect of the toxin is primarily cardiac and results in rhythm alterations and ultimately ventricular fibrillation. As there is no known antidote, and classic antiarrhythmic therapy proves to be ineffective, a prompt diagnosis is of great importance as immediate supportive action is the only valuable alternative. This case describes a 43-year-old women who attempted suicide by ingesting the leaves of taxus Baccata. We discuss the effects and the difficulty of treatment associated with yew leaf poisoning.- - - - - - - - - - ranking = 1keywords = suicide (Clic here for more details about this article) |
3/7. Reversal of citalopram-induced junctional bradycardia with intravenous sodium bicarbonate.The cardiotoxicity of tricyclic antidepressants is a well-described phenomenon requiring serious consideration in patients who have taken an overdose. In patients who are at high risk for suicide attempts, selective serotonin reuptake inhibitors (SSRIs) were thought to constitute a safe alternative. However, evidence is accumulating that they, too, possess proarrhythmic properties, which must be reconciled in the setting of an overdose. An 82-year-old woman intentionally ingested citalopram 1.6 g. Several hours after presentation, she developed sinus arrest and junctional bradycardia that resolved after infusion of intravenous sodium bicarbonate solution. Thereafter, she demonstrated no further electrocardiographic abnormalities and was safely transferred to the psychiatry service without the need for a temporary transvenous pacemaker. The dramatic effect of the sodium bicarbonate on the arrhythmia represents a probable event according to the Naranjo probability scale. Intravenous sodium bicarbonate may serve as an effective antidote to SSRI-induced bradyarrhythmias.- - - - - - - - - - ranking = 1keywords = suicide (Clic here for more details about this article) |
4/7. Oleander poisoning: treatment with digoxin-specific Fab antibody fragments.A 37-year-old man presented two hours after the ingestion of "a handful" of oleander leaves (probably nerium oleander) in a suicide attempt. Cardiotoxicity was evidenced by the presence of bradycardia (rate, 30 to 45) with sinoatrial nodal arrest and junctional escape consistent with a cardiac glycoside effect. The patient was treated empirically with a single dose of five vials (200 mg) of digoxin-specific Fab antibody fragments (Digibind). The pretreatment digoxin level was 1.5 ng/mL. After treatment, the patient's rhythm stabilized with residual sinus bradycardia (rate, 56). The patient recovered uneventfully and was discharged on the fifth hospital day to inpatient psychiatric care.- - - - - - - - - - ranking = 1keywords = suicide (Clic here for more details about this article) |
5/7. Attempted suicide with verapamil.A 28-yr-old woman was admitted to hospital after a suicide attempt in which she had taken 5600 mg verapamil. On admission she exhibited bradycardia and pronounced hypotension; ECG revealed AV dissociation which persisted for 7 1/2 h after admission. She was discharged well 36 h later.- - - - - - - - - - ranking = 5keywords = suicide (Clic here for more details about this article) |
6/7. delayed diagnosis of diltiazem overdose in a patient presenting with thrombosis of femoral artery.Previous cases of diltiazem overdose described patients who presented with hypotension, heart block, bradycardia, or ultimately death. This report concerns an elderly patient presenting to the emergency room with hypotension, an ischemic leg and confusion. He underwent an emergency thrombectomy of the femoral artery. He had severe lactic acidosis, persistent hypotension requiring prolonged inotropic support and difficulty being weaned from the ventilator after the operation. Subsequent investigations confirmed that he attempted suicide by taking an unknown quantity of diltiazem. Because diltiazem has been increasingly prescribed to treat various cardiovascular disorders, overdose may become a more common problem. A high index of suspicion is required to ensure prompt diagnosis and appropriate treatment when patients taking this medication present with sudden circulatory collapse. A guide to the management of diltiazem overdose is provided.- - - - - - - - - - ranking = 1keywords = suicide (Clic here for more details about this article) |
7/7. flecainide overdose: is cardiopulmonary support the treatment?flecainide toxicity can impair cardiac function and precipitate circulatory collapse, which in turn depresses clearance and redistribution of flecainide. Treatment directed at improving cardiac function is often ineffective in the presence of persistently increased flecainide levels. We report a novel approach to severe flecainide overdose using peripheral cardiopulmonary bypass support (CBS) to maintain perfusion of the liver, thereby allowing clearance of the drug. CBS was initiated to resuscitate a young woman who had ingested flecainide in a suicide attempt. The patient had an agonal rhythm, no effective blood pressure, and a flecainide level of 5.4 micrograms/mL (therapeutic range, .2 to 1.0 microgram/mL). During 10 hours of CBS, the flecainide level decreased to 1.4 micrograms/mL, a half-life of 6 hours. Effective cardiac rhythm and blood pressure returned. CBS successfully supported this patient until the flecainide level decreased as a result of redistribution and normal clearance mechanisms. Unfortunately, because of severe neurologic damage sustained at the time of overdose, the patient died 4 days after admission.- - - - - - - - - - ranking = 1keywords = suicide (Clic here for more details about this article) |