We are analyzing https://link.springer.com/article/10.1007/bf03160963.

Title:
Citalopram overdose: Late presentation of torsades de pointes (TdP) with cardiac arrest | Journal of Medical Toxicology
Description:
Introduction Citalopram overdose may produce bradycardia, QT prolongation, and torsades de pointes (TdP). A cardiotoxic metabolite may be responsible for the delayed onset of cardiotoxicity. Although some authorities recommend a minimum of 24 hours of observation following citalopram overdose, a recent analysis suggested that dysrhythmias rarely occur beyond 13 hours post-ingestion. We present a case of citalopram overdose with a substantially delayed onset of cardiac toxicity. Case Report A 36-year-old woman complained of shakiness, numbness in the arms, and palpitations that began approximately 32 hours after ingesting 50 (20-mg) tablets of citalopram. Her initial vital signs were: blood pressure, 84/44 mmHg; pulse, 102–150/minute; respirations, 17/min; temperature, 99.3° F (37.3° C). Her initial ECG showed sinus rhythm with a prolonged corrected QT interval (572 msec) with paroxysmal, self-limited runs of wide-complex tachycardia that appeared multifocal in nature. Approximately 20 minutes after presentation, she experienced self-terminating TdP, with transient hypotension and loss of consciousness. Her serum citalopram concentration (33 hours post-ingestion) was 477 ng/mL (therapeutic: 40–110 ng/mL); desmethylcitalopram concentration was 123.2 ng/mL (therapeutic: 14–40 ng/mL). She was treated with magnesium and lidocaine, and her corrected QT interval remained abnormal for 24 hours after presentation. Discussion Citalopram overdose can produce life-threatening cardiac toxicity with a clinical onset that may be delayed beyond a routine observation period of 6 hours. Once the QT interval is prolonged, it seems prudent to prolong the observation period.
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g-protein-activated inwardly rectifying month download article/chapter evidence-based consensus guideline medical toxicology aims citalopram-induced brady-cardia torsades de pointes wide-complex tachycardia related subjects serotonin reuptake inhibitors full article pdf qtc interval prolongation privacy choices/manage cookies uptake inhibitor citalopram york university school european economic area dysrhythmias rarely occur initial vital signs pharmacokinetic-pharmacodynamic modeling friberg le pharmacokinetic-pharmacodynamic modelling cardiac treatment drugs citalopram-pharmacological profile severe citalopram overdose citalopram product monograph conditions privacy policy isbister gk comparative study qt interval prolongation check access instant access serum citalopram concentration citalopram overdose—review article journal accepting optional cookies 13 hours post-ingestion 33 hours post-ingestion journal finder publish late onset seizures main content log toxicol/clin toxicol 2004 toxicol/clin toxicol 1997 recent analysis suggested substantially delayed onset routine observation period article log author correspondence selective serotonin article tarabar cardiac arrest article cite

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