title: Acute zonisamide overdose: a death revisited.
abstract: Overdose experience with the anti-epileptic agent zonisamide (Zonegran, ZNS) is limited. We present a case of suspected zonisamide overdose previously reported in abstract form, manifesting as seizures, dysrhythmias and death of an 18-y-o woman after single ingestion of 4.8 g ZNS in a suicide attempt. The patient experienced multiple generalized tonic-clonic seizures and copious airway secretions. En route to the emergency department, she sustained cardiopulmonary arrest from which she was resuscitated. CT scan of the head approximately 24 h after initial presentation revealed massive cerebral edema with tonsillar herniation; brain death was confirmed. Serum ZNS was 44 mg/L, and the case was officially deemed death secondary to ZNS overdose. Subsequently, a comprehensive urine drug screen demonstrated mirtazepine, diphenhydramine metabolites, and caffeine. Due to confounding factors, a definitive causal role for ZNS in this overdose death cannot be made, despite the county coroner's ruling.
authors.affiliation: Department of Pediatrics, Drug and the Poison Information Center, Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Sztajnkrycer
authors.forename: E E
authors.initials: EE
authors.lastname: Huang
authors.forename: G R
authors.initials: GR
authors.lastname: Bond
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000506:poisoning*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D016887:Cardiopulmonary Resuscitation; D003937:Diagnosis, Differential; D062787:Drug Overdose / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D004562:Electrocardiography; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000000981:diagnostic imaging; D007555:Isoxazoles / Q000506:poisoning*; D013406:Suicide, Attempted; D014057:Tomography, X-Ray Computed; D000078305:Zonisamide
chemical_list: D000927:Anticonvulsants; D007555:Isoxazoles; D000078305:Zonisamide