Intravenous lipid emulsion as rescue therapy in severe quetiapine overdose: A case report.
This case suggests that intravenous lipid emulsion may be considered as a rescue therapy in severe quetiapine overdose when conventional measures fail, but further evidence is needed to establish its efficacy.
Where it sits
this study against the rest of the mazdutide (ibi362) corpusSummary and findings
This case report describes a 25-year-old woman who intentionally ingested approximately 4.5 g of quetiapine and developed severe neurological deterioration and refractory distributive shock. A 20% intravenous lipid emulsion was administered as rescue therapy, leading to marked neurological improvement and hemodynamic stabilization within hours. No treatment-related adverse events were reported.
Abstract
Severe quetiapine overdose may lead to central nervous system depression and cardiovascular instability; however, refractory distributive shock is an uncommon and life-threatening presentation. Intravenous lipid emulsion has emerged as a potential adjunctive therapy in intoxications caused by highly lipophilic drugs, although evidence remains limited. We report the case of a 25-year-old woman with intentional ingestion of approximately 4.5 g of quetiapine, who developed progressive neurological deterioration and refractory distributive shock despite mechanical ventilation and dual vasopressor support. Laboratory findings showed severe metabolic acidosis with hyperlactataemia, and echocardiography revealed a hyperdynamic profile with reduced systemic vascular resistance. Given the persistence of haemodynamic instability and neurological impairment, a 20% intravenous lipid emulsion was administered as rescue therapy. Within three hours, the patient exhibited marked neurological improvement, with recovery of consciousness (Glasgow Coma Scale score 14/15), along with progressive haemodynamic stabilization allowing discontinuation of vasopressors. Lactate levels normalized within 9 h, and the patient was successfully extubated at 24 h, with no treatment-related adverse events. This case highlights the potential role of intravenous lipid emulsion as an adjunctive rescue therapy in severe quetiapine intoxication with refractory haemodynamic and neurological compromise. Although causality cannot be definitively established, the temporal association and rapid clinical response support its consideration when conventional supportive measures are insufficient.
Background
Severe quetiapine overdose can result in central nervous system depression and cardiovascular instability, with refractory distributive shock being a rare but critical outcome. Previous literature has suggested that intravenous lipid emulsion may serve as an adjunctive therapy for overdoses involving lipophilic drugs, although the evidence supporting its efficacy is limited. This case report aims to provide insight into the potential role of intravenous lipid emulsion in such scenarios.
Methods
This is a case report of a 25-year-old woman who ingested approximately 4.5 g of quetiapine. The patient developed neurological deterioration and refractory distributive shock despite mechanical ventilation and dual vasopressor support. A 20% intravenous lipid emulsion was administered as rescue therapy, and outcomes were monitored over a period of hours.
Results
The administration of 20% intravenous lipid emulsion resulted in a Glasgow Coma Scale score improvement to 14/15 within three hours. Lactate levels normalized within 9 hours, and the patient was extubated successfully at 24 hours. No treatment-related adverse events were reported.
Interpretation
While the rapid clinical response following the administration of intravenous lipid emulsion is noteworthy, it is essential to recognize that this is a single case report and does not provide definitive evidence of causality. The improvement in neurological status and hemodynamic stability may be attributed to the lipid emulsion, but confounding factors such as concurrent supportive measures cannot be ruled out. Further studies are needed to validate these findings and assess the clinical significance of intravenous lipid emulsion in severe quetiapine overdose.
Key findings
- Approximately 4.5 g of quetiapine ingested.
- Glasgow Coma Scale score improved to 14/15 within three hours.
- Lactate levels normalized within 9 hours.
- Patient successfully extubated at 24 hours.
Limitations
- Single case report limits generalizability.
- Causality cannot be definitively established.
- No control group for comparison.