SSRI

Question 1

What are the SSRI and the dose that we would be worried about in toxic overdose?

Answer 1

Citalopram >600mg
Escitalopram >300mg

Question 2

What are the toxic mechanism in SSRI overdose?

Answer 2

1. Serotonin syndrome
2. Prolong QT and risk of Torsades de Points

Question 3

What are the symptoms of serotonin syndrome?

Answer 3

Fever
Mental state: Confusion, Anxiety, Agitation, Delirium, Coma
Autonomic instability: Tachycardia, Hypertension, Hyperthermia, Diaphoresis, Nausea, Vomiting, Diarrhoea
Neuromuscular: Hyper-reflexia, Clonus, Hypertonicity, Tremor, Seizures

Fever MAN

Question 4

How do you manage serotonin toxicity?

Answer 4

Increase anxiety, sweating, tremor, tachycardia may herald onset of seizures -> Give midazolam

Immediate life threats:
* Severe rigidity compromising ventilation
* Hyperthermia
* Altered mental status

RSI, ventilation, neuromuscular paralysis for severe toxicity/ no response to benzodiazepines

Temperature>38.5 requies continous core monitoring
Temperature >39.5 requires prompt paralysis and active cooling to prevent MODS, Neurological injury, and Death

Question 5

How do you manage TdP in SSRI overdose?

Answer 5

• Cardioversion if hemodynamic instability
• Magnesium 10mmol IV bolus (0.05mmol/kg in children)
• Isoprenaline or Overdrive pacing
• Ensure all QT dependent electrolytes (Potassium, Calcium, Magnesium) are at Upper Limit Normal
• Cardiac monitoring for 12 hours if citalopram >600mg/ escitalopram >300mg