Introduction. Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) that is used in the management of depression and obsessive compulsive disorders. We report a patient with status epilepticus requiring quadruple anti-convulsant treatment following a fluvoxamine overdose. Case Report. A 25-year-old female presented with drowsiness at 12 hours following deliberate ingestion of 9.6 grams of fluvoxamine. Sixteen hours after ingestion, she developed status epilepticus that required treatment with benzodiazepines (lorazepam and midazolam), thiopentone, phenytoin and phenobarbitone. Her serum fluvoxamine concentration on presentation was 1970 μg/L (therapeutic 160-220 μg/L) and routine toxicological screening was negative for other drugs. She was discharged home after 72 hours with no further episodes of seizures. Discussion. Most patients with fluvoxamine poisoning are either asymptomatic or may develop mild signs of serotonergic toxicity. Although serotonin syndrome and isolated seizures are reported in fluvoxamine poisoning, we report the first patient with confirmed isolated fluvoxamine toxicity who developed status epilepticus.

The difficult-to-wean patient represents 6% of the intensive care population, but consumes a third of resources. Such patients experience increased morbidity and mortality. Given the changing demographics of intensive care practice, this patient group is likely to grow. Hitherto management of the difficult wean is rarely debated, though there exists a clear demand for further exploration. Here we present often overlooked, modifiable patient factors to optimise the chance of weaning success. The mechanism of weaning, trouble-shooting, continuing and limiting treatment are subsequently explored.

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