Coma After Quetiapine Fumarate Intentional Overdose in a 71-year-old Man: A Case Report.

A 71-year-old man developed coma with severe respiratory failure, hypotension, and tachycardia induced by the intentional ingestion of quetiapine fumarate extended release (XR) 20 g. At the time, he had been treated for bipolar depression with venlafaxine 75 mg/day, lamotrigine 100 mg/day, pregabalin 75 mg/day, and quetiapine XR 400 mg/day for approximately 1 year. Comorbidities were hypertension treated with metoprolol, diabetes mellitus type 2 treated with metformin, and benign prostatic hyperplasia treated with silodosin. In the emergency room, about 4 h after ingestion of quetiapine fumarate XR, the presenting symptomatology was characterized by coma (Glasgow Coma Scale score 3), hypotension (blood pressure [BP] 90/60 mmHg), tachycardia (electrocardiogram [ECG] showed sinus tachycardia with heart rate 120 beats per minute and a QTc of 499 ms). A gastric lavage was performed and activated charcoal 50 g and magnesium sulfate 30 g was administered. About 6 h after ingestion, he developed marked desaturation and underwent mechanical ventilation; 13 h after ingestion, a severe hypotensive episode followed (BP 70/40), which was treated with an infusion of ringer lactate 500 cc. On the 3rd day after intentional overdose, an episode of agitation occurred; 4 days after ingestion, the quetiapine plasma level was found to be 42 ng/ml (within therapeutic range). At 5 days after ingestion, the patient developed septicemia caused by staphylococci (probably originating from the central vein catheter), which was treated with antibiotic therapy. On days 10 and 18 after the suicide attempt, two episodes of paroxysmal supraventricular tachycardia (PSVT) occurred and were successfully treated with intravenous adenosine triphosphate. The patient recovered completely without residual symptoms. In line with literature data, in this case report, symptoms of quetiapine overdose were tachycardia, agitation, hypotension, QT interval prolongation, and coma. A causal relationship between PSVT and quetiapine intoxication seems quite unlikely due to the drug level.

Daily modifications of plasma fibrinogen platelets aggregation, Howell's time, PTT, TT, and antithrombin II in normal subjects and in patients with vascular disease.

The possibility of occurrence of daily variations in blood fibrinogen levels, platelets aggregation. Howell's time values and values for PTT, TT and antithrombin III was explored in 10 healthy subjects and in 10 patients with vascular disease. In normal subjects blood fibrinogen, platelets aggregation in ADP, PTT, Howell's time and TT values showed statistically significant daily variations, while the AT III values showed no significant variations over the 24-h cycle. In patients with vascular disease, on the other hand, the daily variations of the fibrinogen blood levels, of the maximum amplitude of platelets aggregation and of the Howell's values were not detected. In fact, the first two parameters remained consistently high and the third parameter remained consistently low throughout the 24-h cycle. In contrast, the PTT as well as the TT values in these patients showed statistically significant daily variations but with time patterns different than those found in normal subjects. Also, unlike to what obtained in healthy subjects, the AT III values in patients with vascular disease showed highly significant variations over the period of 24-h.

Effects of ketoprofen on the calciuric and uricosuric activities of calcitonin in man.

The action of ketoprofen on the calciuric and uricosuric effects of porcine calcitonin in man is reported. The drug is capable of inhibiting both effects. This action is considered like an effect on CT receptors in the kidney or a competitive action on prostaglandin synthesis.