Ziprasidone Overdose
Mr. A, a 50-year-old man with a well-established diagnosis of chronic paranoid schizophrenia, was admitted to a hospital’s emergency department 4.5 hours after an overdose of 3120 mg of ziprasidone (52 60-mg tablets of ziprasidone and 26 placebo tablets). He said he had not taken any other prescribed or illicit drugs or drunk any alcohol; he had not vomited. He was conscious and cooperative.Mr. A was connected to a cardiac monitor and a pulse oximeter. His Glasgow Coma Scale (3) score was 15. His blood pressure at admission was 200/95 mm Hg; it decreased to 160/80 mm Hg within 1.5 hours; then it remained in the normal range. His axillary temperature was 36.5°C. His pulse ranged from 70 to 90 bpm. His Sao2 was between 96% and 99% with room air. He was a little drowsy, and his speech was slightly slurred.An ECG performed on Mr. A showed some minimal QT prolongation (QT/QTc 430/490 msec) and nonspecific flattening of the T wave. He had no arrhythmias. Four ECGs per hour were performed. Blood was taken for a CBC, to check liver function, and to test electrolyte, magnesium, and acetaminophen levels. The results were within normal limits. An intravenous infusion with normal saline solution was begun at a rate of 8 liters per hour. An intravenous infusion of 10 mg of metoclopramide was given, along with 50 mg of oral charcoal and 150 ml of sorbitol.Mr. A’s first two postoverdose ECGs showed minimal QT prolongation and nonspecific change in the morphology of the T wave compared to his pretreatment ECG. This change was maximal at 6 hours postoverdose, which would correlate with the peak plasma level of ziprasidone (4). His ECG readings then returned to normal.
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