Introduction: Clozapine is a frequently prescribed atypical antipsychotic drug. Various case reports documented the successful recovery of acute antipsychotics toxicity in association with the administration of intralipid emulsion (ILE). Aim: This study aimed to assess the adjuvant therapeutic role of SMOF Lipid administration on the outcomes of acute clozapine poisoning. Methods: Forty patients with acute clozapine poisoning were randomly allocated into two equal groups. The control group received the standard supportive treatment only, whereas the intervention group received the standard supportive treatment plus SMOF Lipid 20% infusion. All patients were subjected to history taking, full clinical examination, and laboratory investigations. The study outcomes were evaluated. Results: The mean Glasgow Coma Scale (GCS) at 6 hours (13.1 ± 2.3 vs 9.2 ± 2, p < 0.001) and 12 hours (14.3 ± 1.5 vs 9.6 ± 2, p < 0.001) after admission was significantly higher in the intervention group compared to the control group. The intervention group showed a significantly lower frequency of prolonged QTc interval 12 hours after admission (p = 0.003), as well as a significantly shorter hospital stay (p < 0.001). Conclusions: SMOF Lipid infusion seemed to have improved GCS, the prolonged QTc interval, and shortened the length of hospital stay. Furthermore, there were no adverse effects related to its administration.

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Background: Antipsychotics toxicity is one of the top five substances most frequently included in human poisoning. Various case reports documented successful use of intravenous lipid emulsion (ILE) in the management of acute antipsychotics poisoning. Aim: The aim of this study was to assess the efficacy and safety of ILE as adjuvant therapy for acute antipsychotic poisoning. Patients and methods: Forty patients presented with moderate to severe acute antipsychotic poisoning were randomly allocated into two equal groups. The control group was given the standard treatment only while the intervention group was given the standard treatment plus ILE infusion. For all patients, history, clinical examination, ECG, and laboratory investigations were done. The safety and efficacy outcomes were evaluated. Results: results revealed that the median Glasgow Coma Scale assessed at 6 and 12 hours after admission was significantly higher in the intervention group compared to the control group. Both corrected QT intervals measured 12 hours after admission and period of hospital stay were significantly shorter in the intervention group compared to the control group. During follow-up of the intervention group, there were no significant differences between serum triglycerides levels, liver enzymes and, platelet count measured at admission and 12 hours later. Conclusion: It was concluded that ILE was a safe and effective therapy for acute antipsychotic poisoning.

Introduction: Clozapine is the most effective antipsychotic drug for the treatment of refractory schizophrenia. It is also seen as the most toxic in its class. Drug poisoning has been detected as one of the major causes of intensive care unit (ICU) admission. The study aimed to develop a decision tool using readily available parameters in the emergency room for patients with acute clozapine poisoning to identify patients who need ICU admission. Patients and Methods: This retrospective cohort study was carried out on 121 patients with acute clozapine poisoning admitted to the Tanta University Poison Control Center. For each patient, demographic, toxicological, clinical data, laboratory findings, and electrocardiography records were analyzed against ICU admission. Results: The results revealed that 29 patients needed ICU admission, and they were significantly older than patients who did not. A significant association was found between the history of addiction and/or psychiatric illness, mode of poisoning, amount and dose of clozapine, and the need for ICU admission. Patients admitted to ICU had a significantly higher percentage of tachycardia, tachypnea, and hyperthermia, while they had a lower Glasgow Coma Scale (GCS) and oxygen saturation. Besides, they had a significantly higher percentage of hyperglycemia, respiratory alkalosis, and prolonged QTc interval. There was a significant association between the need for ICU admission and both electrocardiogram (ECG) severity grading and acute clozapine poisoning severity score. The logistic regression model showed that large doses of clozapine, tachypnea, increased the severity of ECG grading, and decreased level of O2 saturation on admission significantly increased the probability of requiring ICU admission. Based on receiver operating characteristic curve analysis, take a dose of clozapine at a cut-off value above 250 mg is a good predictor of the need for ICU admission. Conclusion: It could be concluded that higher taken doses of clozapine, tachypnea, low O2 saturation, and increased severity of ECG grading are considered independent predictors of the need for ICU admission in acute clozapine poisoned patients.

Organophosphorus compounds are widely used pesticides. They are associated with a significant risk of acute intoxication. Oxidative stress is a contributing factor of acute organophosphorus poisoning morbidity and mortality. L-carnitine was found to have free-radical scavenging and antioxidant properties. Therefore, we aimed to evaluate the efficacy and safety of L-carnitine as an adjuvant in treatment of patients with acute organophosphorus poisoning. A randomized clinical trial was conducted on 30 patients suffering from acute organophosphorus poisoning admitted to Poison Control Center, Tanta University Emergency Hospital, Egypt, from April 2017 till January 2018. Patients were randomly divided into two equal groups. Group I received the standard treatment only and group II received the standard treatment plus L-carnitine in a dose of 1gm/8 hours IV.At time of admission, malondialdehyde, reduced glutathione, serum total antioxidant capacity and psudocholinesterase enzyme activity registered no significant difference between the two studied groups. After treatment, malondialdehyde, reduced glutathione and serum total antioxidant capacity showed significant improvement in group II. The mean value of atropine dose in group II (5.6mg) was significantly lower than group I(10.9mg). We concluded that the use of L-carnitine improved the antioxidant status and reduced total atropine dose required for treatment of patients with acute organophosphorus poisoning.