FLUOXETINE-INDUCED CARDIOTOXICITY WITH RESPONSE TO BICARBONATE THERAPY

This report describes a patient with an acute intentional fluoxetine e xposure who developed unique cardiovascular and neurovascular toxicity . The patient presented with lethargy and cardiac conduction delays (Q RS 110 msec, QT(c) 458 msec) and developed a delayed seizure, On admis sion, therapy with intravenous sodium bicarbonate promptly narrowed th e QRS to 90 msec, A comprehensive toxicology screen demonstrated only a serum fluoxetine concentration of 901 ng/mL (therapeutic range, 37-3 01), a serum norfluoxetine concentration of 451 ng/mL (29-329) and a s erum acetaminophen concentration of 174 mg/L, Tricyclic antidepressant s were specifically noted to be absent, A self-limiting generalized se izure was witnessed 16 hours after ingestion, At this time the bicarbo nate infusion had been ceased and the QRS interval was not prolonged, The patient improved overtime and no other apparent causes for the obs erved clinical effects could be discovered. Emergency physicians need to be aware of the uncommon occurrence of fluoxetine-induced cardiotox icity and the potential benefit of sodium bicarbonate therapy. (Am J E merg Med 1997;15:501-503. Copyright (C) 1997 by W.B. Saunders Company) .