title: Adult respiratory distress syndrome and renal failure associated with citalopram overdose.
abstract: A 45-year-old man ingested 3000 mg of citalopram hydrobromide (2400 mg citalopram). He presented to the Emergency Department 2 hours post-ingestion with a pulse of 100 beats/min and blood pressure of 120/80 mmHg. His electrocardiogram (ECG) was normal. Chest X-ray showed bilateral shadowing, with no evidence of aspiration of gastric contents. Shortly after, he had three tonic-clonic seizures, requiring intravenous diazepam. Eight hours post-ingestion he became oliguric with deteriorating renal function, despite normal arterial and central venous pressures. He became increasingly hypoxic, with chest X-ray changes compatible with adult respiratory distress syndrome (ARDS). Despite treatment with 100% oxygen and continuous positive airway pressure, his gas exchange continued to deteriorate, requiring intubation and ventilation. His renal function also deteriorated with a peak creatinine of 492 micromol/L on day 4 in the absence of rhabdomyolysis. There was complete spontaneous recovery of renal function after 2 weeks. A peak plasma total citalopram (R+S enantiomers) concentration of 1.92 mg/L was recorded 2 hours post-ingestion. Total norcitalopram concentrations continued to rise up to 24 hours post-ingestion. Citalopram has been associated with seizures, ECG abnormalities, rhabdomyolysis and coma after overdose. The renal and respiratory complications seen in this patient have not been reported previously.
authors.affiliation: Scottish Poisons Information Bureau, Royal Infirmary, Edinburgh, UK. cathy.kelly@luht.scot.nhs.uk
authors.forename: C A
authors.initials: CA
authors.lastname: Kelly
authors.forename: A
authors.initials: A
authors.lastname: Upex
authors.forename: E P
authors.initials: EP
authors.lastname: Spencer
authors.forename: R J
authors.initials: RJ
authors.lastname: Flanagan
authors.forename: D N
authors.initials: DN
authors.lastname: Bateman
mesh_terms: D015283:Citalopram / Q000097:blood / Q000506:poisoning*; D062787:Drug Overdose; D006801:Humans; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D051437:Renal Insufficiency / Q000209:etiology / Q000503:physiopathology; D012128:Respiratory Distress Syndrome / Q000139:chemically induced* / Q000473:pathology; D017367:Selective Serotonin Reuptake Inhibitors / Q000097:blood / Q000506:poisoning*; D013406:Suicide, Attempted; D016896:Treatment Outcome
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors