ABSTRACT
A 14-year-old young adult took an overdose of 1.2 g of fluoxetine, a selective serotonin reuptake inhibitor (SSRI) that he had been prescribed for depression. He had a generalised tonic/clonic seizure at 6 hours postingestion.After the seizure, he developed signs consistent with serotonin syndrome: fine tremor, agitation, sweating and hyperreflexia. This was followed by severe muscle pain and rhabdomyolysis with peak creatine kinase (CK) of 33 941 at 74 hours. He was managed with intravenous fluids and analgesia and discharged after 4 days, having avoided renal injury. The use of SSRI's such as fluoxetine in teenagers has increased in recent years. While it is generally considered benign in overdose, this report illustrates the severe consequences of overdose at high quantities and discusses appropriate management in these cases. We note that in this case, there was a delayed onset of rhabdomyolysis with peak CK at 74 hours postingestion.
Subject(s)
Drug Overdose/diagnosis , Fluoxetine/adverse effects , Rhabdomyolysis/diagnosis , Seizures/diagnosis , Selective Serotonin Reuptake Inhibitors/adverse effects , Serotonin Syndrome/diagnosis , Adolescent , Depressive Disorder/drug therapy , Diagnosis, Differential , Drug Overdose/blood , Drug Overdose/complications , Humans , Male , Rhabdomyolysis/blood , Rhabdomyolysis/complications , Seizures/blood , Seizures/complications , Serotonin Syndrome/blood , Serotonin Syndrome/complications , Suicide, AttemptedABSTRACT
UNLABELLED: Adolescence is a time of many changes with growing independence, emotional and physical changes. It is essential that we as health care professionals are proactive in ensuring good communication and confidentiality in adolescent consultations. OBJECTIVE: To understand our practice in this area of communication and confidentiality with adolescents. METHOD: We conducted a questionnaire based survey among clinicians involved in the care of adolescents whether the clinicians asked the adolescents if they wanted to be seen on their own. RESULTS: Only 23% of the clinicians routinely asked. Of those surveyed, 43% thought it was not essential and 30% stated they did not have enough time. Only 25% copied clinic letters to adolescents along with their parents. CONCLUSION: The results show that there is a lack of awareness of the need to start giving adolescents more independence to ensure a smooth transition to adulthood. Numerous learning resources are available to clinicians to help them understand adolescent care better.
