Severe quetiapine voluntary overdose successfully treated with a new hemoperfusion sorbent

Giuntoli, L; Dalmastri, Vittorio; Cilloni, Nicola; Orsi, Claudio; Stalteri, Lucia; Demelas, Valentina; Giuliani, Giovanni; Gordini, Giovanni; Ponti, Fabrizio De; Manna, Gaetano La

doi:10.1177/0391398819837686

Cited by 17 publications

(13 citation statements)

References 18 publications

(44 reference statements)

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“…Several case reports have documented the potential benefit of CytoSorb hemoadsorption in severe intoxications (e.g., flecainide [4], quetiapine [5], and venlafaxine [6]). However, the present study is the first to report on the successful use of CytoSorb for severe digitoxin intoxication.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Successful Treatment of Severe Digitoxin Intoxication with CytoSorb® Hemoadsorption

et al. 2020

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While several intoxications can be successfully treated with specific antidotes, intoxications with the steroid glycoside digitoxin still represent a major challenge. Besides conventional approaches, CytoSorb® hemoadsorption might be another treatment option. We report on an 81-year-old female patient treated in our intensive care unit (ICU) with severe digitoxin intoxication, acute renal failure, and urinary tract infection (UTI). As physiological digitoxin elimination kinetics are known to appear slow, and also in regard to the renal failure, the decision was made to initiate continuous renal replacement therapy combined with CytoSorb hemoadsorption. The patient was hemodynamically stabilized within the first 4 h of treatment and initially required catecholamines to be stopped within 24 h of treatment. Pre- and post-adsorber drug level measurements showed a rapid elimination of digitoxin. Antibiotic treatment with piperacillin/tazobactam was initiated, and despite CytoSorb hemoadsorption therapy and its known potential to reduce plasma concentrations of several drugs, the UTI was successfully treated. After 3 days of CytoSorb treatment, digitoxin plasma levels were stable and almost normalized, and no clinical signs of intoxication were present. Five days after presentation, the patient was transferred from the ICU in a stable condition. CytoSorb hemoadsorption may be an easily available, efficient, and less cost-intensive therapy option than treatment with the Fab fragment, which is the currently recommended therapy for digitalis intoxications. Therefore, the use of CytoSorb might represent an alternative treatment for life-threatening complications of digitoxin intoxications.

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Section: Discussion/conclusionmentioning

confidence: 99%

Successful Treatment of Severe Digitoxin Intoxication with CytoSorb® Hemoadsorption

et al. 2020

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“…On the other hand, this might represent an opportunity for therapeutic use in detoxification. A recent case report demonstrated that use of the CytoSorb hempoadsorption was associated with an accelerated reduction in quetiapine plasma levels 7 . However, concentrations of its active metabolite norquetiapine as well as pre‐ and post‐cartridge quetiapine measurements to directly assess adsorber effectiveness had not been performed.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Successful treatment of severe quetiapine intoxication with CytoSorb hemoadsorption

Reuchsel

Gonnert

2022

Clinical Pharmacy Therapeu

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What is known and objective: While many drug poisonings are successfully treated with specific antidotes, intoxications with tricyclic antidepressants and/or atypical neuroleptics still represent a major challenge. Besides conventional approaches, a new hemoadsorption device might represent an opportunity for therapeutic detoxification. Case summary:We report a 64-year-old female patient who attempted suicide by ingesting an unknown dose of quetiapine. Following application of all available standard diagnostic and therapeutic measures, she was admitted to the intensive care in a deeply somnolent state. Gastroscopy was performed necessitating analgo-sedation, intubation, and mechanical ventilation. Since quetiapine is in principle not dialysable, CytoSorb hemoadsorption was commenced resulting in a clear and rapid decrease in plasma levels of quetiapine and its metabolite norquetiapine over the next few hours.The next day, analgesia was stopped, the patient became alert, and cooperative so that she could be extubated without issues. CytoSorb blood purification therapy was discontinued after 2 days. One day later, the patient was transferred to a psychiatric clinic.

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“…Maximization of blood flow rapidly leads to high clearance in time-critical situations. The duration of therapy, blood flow rates, and changing intervals considering the adsorber saturation kinetics should be individually adjusted to achieve optimal clearance [ 127 , 141 , 142 , 143 , 144 ].…”

Section: Hemoadsorption With Cytosorb ®mentioning

confidence: 99%

Therapeutic Modulation of the Host Defense by Hemoadsorption with CytoSorb®—Basics, Indications and Perspectives—A Scoping Review

Köhler

Schwier

Praxenthaler

et al. 2021

IJMS

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The “normal” immune response to an insult triggers a highly regulated response determined by the interaction of various immunocompetent cells with pro- and anti-inflammatory cytokines. Under pathologic conditions, the massive elevation of cytokine levels (“cytokine storm”) could not be controlled until the recent development of hemoadsorption devices that are able to extract a variety of different DAMPs, PAMPs, and metabolic products from the blood. CytoSorb® has been approved for adjunctive sepsis therapy since 2011. This review aims to summarize theoretical knowledge, in vitro results, and clinical findings to provide the clinician with pragmatic guidance for daily practice. English-language and peer-reviewed literature identified by a selective literature search in PubMed and published between January 2016 and May 2021 was included. Hemoadsorption can be used successfully as adjunct to a complex therapeutic regimen for various conditions. To the contrary, this nonspecific intervention may potentially worsen patient outcomes in complex immunological processes. CytoSorb® therapy appears to be safe and useful in various diseases (e.g., rhabdomyolysis, liver failure, or intoxications) as well as in septic shock or cytokine release syndrome, although a conclusive assessment of treatment benefit is not possible and no survival benefit has yet been demonstrated in randomized controlled trials.

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Severe quetiapine voluntary overdose successfully treated with a new hemoperfusion sorbent

Cited by 17 publications

References 18 publications

Successful Treatment of Severe Digitoxin Intoxication with CytoSorb® Hemoadsorption

Successful Treatment of Severe Digitoxin Intoxication with CytoSorb® Hemoadsorption

Successful treatment of severe quetiapine intoxication with CytoSorb hemoadsorption

Therapeutic Modulation of the Host Defense by Hemoadsorption with CytoSorb®—Basics, Indications and Perspectives—A Scoping Review

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