Abstract | CONTEXT: CASE DETAILS: A 16 year-old female with a seizure disorder was found unresponsive in pulseless ventricular tachycardia after intentionally ingesting 4.5 g (76 mg/kg) lacosamide, 120 mg (2 mg/kg) cyclobenzaprine and an unknown amount of levetiracetam. Exact time of ingestion was unknown. Her initial electrocardiogram (ECG) demonstrated sinus tachycardia at 139 beats per minute, QRS duration 112 ms, and terminal R-wave in lead aVR > 3 mm. Despite treatment with 150 mEq of sodium bicarbonate, she had persistent EKG findings eight hours after presentation. Her serum lacosamide concentration nine hours after presentation was elevated at 22.8 μg/mL, while serum cyclobenzaprine concentration was 16 ng/mL (therapeutic: 10-30 ng/mL), and serum levetiracetam concentration was 22.7 μg/mL (therapeutic: 12-46 μg/mL). On hospital day three, ECG demonstrated resolution of the terminal R-wave with QRS of 78 ms. The patient recovered without physical or neurologic sequelae. DISCUSSION:
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Authors | Jenny L Chua-Tuan, Dazhe Cao, Janetta L Iwanicki, Christopher O Hoyte |
Journal | Clinical toxicology (Philadelphia, Pa.)
(Clin Toxicol (Phila))
Vol. 53
Issue 6
Pg. 565-8
(Jul 2015)
ISSN: 1556-9519 [Electronic] England |
PMID | 25951877
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Acetamides
- Anticonvulsants
- Sodium Channel Blockers
- Sodium Channels
- Amitriptyline
- Levetiracetam
- Lacosamide
- cyclobenzaprine
- Sodium Bicarbonate
- Piracetam
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Topics |
- Acetamides
(blood, poisoning)
- Adolescent
- Amitriptyline
(analogs & derivatives, poisoning)
- Anticonvulsants
(blood, poisoning)
- Drug Interactions
- Drug Overdose
- Electrocardiography
- Epilepsy
(drug therapy)
- Female
- Heart Arrest
(chemically induced, diagnosis, metabolism, therapy)
- Humans
- Lacosamide
- Levetiracetam
- Piracetam
(analogs & derivatives, poisoning)
- Risk Factors
- Sodium Bicarbonate
(therapeutic use)
- Sodium Channel Blockers
(poisoning)
- Sodium Channels
(drug effects, metabolism)
- Suicide, Attempted
- Tachycardia, Ventricular
(chemically induced, diagnosis, metabolism, therapy)
- Treatment Outcome
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