ABSTRACT
INTRODUCTION: Escitalopram is rarely associated with prolongation of the QTc interval; however, there are no reported cases of QRS complex widening associated with escitalopram overdose. We report a case of a patient who presented with both QRS complex widening and QTc interval prolongation after an escitalopram overdose. CASE: A 16-year-old girl presented to the emergency department after ingestion of escitalopram, tramadol/acetaminophen, and hydrocodone/acetaminophen. Laboratory results were significant for 4-hour acetaminophen 21.1 µg/mL. Serum electrolytes including potassium, magnesium, and calcium were all normal. Initial electrocardiogram (ECG) revealed a widened QRS with an incomplete right bundle branch pattern. After administration of 100-mEq sodium bicarbonate, a repeat ECG revealed narrowing of the QRS complex and a prolonged QTc interval. Magnesium sulfate 2 g intravenous and sodium bicarbonate drip were initiated. A repeat ECG, 1 hour after the second, revealed normalization of the QRS complex and QTc interval. DISCUSSION: Prolongation of the QTc interval is an expected effect of escitalopram. Both escitalopram and citalopram are metabolized to the cardiotoxic metabolite S-didesmethylcitalopram and didesmethylcitalopram, respectively, which have been implicated in numerous cardiac abnormalities including widening of the QRS complex. Although never previously described with escitalopram, this mechanism provides a reasonable explanation for the QRS complex widening and incomplete right bundle branch block that occurred in our patient. CONCLUSIONS: Both QRS complex widening and QTc interval prolongation should be monitored in cases of escitalopram and citalopram overdoses.
Subject(s)
Bundle-Branch Block/chemically induced , Citalopram/poisoning , Electrocardiography/drug effects , Heart Conduction System/drug effects , Sodium Channels/drug effects , Acetaminophen/poisoning , Adolescent , Antidotes/administration & dosage , Antidotes/therapeutic use , Bradycardia/chemically induced , Bradycardia/drug therapy , Bundle-Branch Block/blood , Bundle-Branch Block/drug therapy , Bundle-Branch Block/physiopathology , Citalopram/analogs & derivatives , Citalopram/blood , Citalopram/pharmacokinetics , Citalopram/pharmacology , Citalopram/toxicity , Delayed Rectifier Potassium Channels/drug effects , Drug Therapy, Combination , Emergencies , Female , Humans , Hydrocodone/poisoning , Long QT Syndrome/chemically induced , Magnesium Sulfate/administration & dosage , Magnesium Sulfate/therapeutic use , Sodium Bicarbonate/administration & dosage , Sodium Bicarbonate/therapeutic use , Suicide, Attempted , Syncope, Vasovagal/chemically induced , Tramadol/poisoningABSTRACT
Extension of primary lung tumors into the left atrium via pulmonary veins is a well-documented phenomenon. Peripheral arterial embolism and cerebral embolism originating from a primary lung neoplasm are rare events. We report a case of simultaneous acute bilateral lower limb ischemia, bilateral renal infarction, splenic infarction and cerebral infarction as a result of multiple emboli originating from primary lung malignancy invasion of the left atrium. An emergent embolectomy revealed pathologic features of the extracted thrombus that were identical to the pulmonary neoplasm.
ABSTRACT
BACKGROUND: Spontaneous postpartum rupture of a Sertoli-Leydig cell ovarian tumor is an infrequent complication of a rare tumor. CASE: A 21-year-old nullipara with an uneventful prenatal course and spontaneous vaginal delivery experienced severe intraabdominal bleeding with hypovolemic shock postpartum from the rupture of a previously undiagnosed Sertoli-Leydig cell ovarian tumor. Diagnosis and intervention were delayed because of the late development of overt signs of intraabdominal bleeding and misleading findings on abdominal examination. Vigorous uterine compression may have precipitated the bleeding. Emergency exploration and surgical intervention were successfully undertaken. Full staging of the cancer was not possible at the initial surgery because of the patient's cardiovascular instability. CONCLUSION: Rupture of a Sertoli-Leydig cell tumor is a potential cause of postpartum hypovolemic shock resulting from massive intraabdominal bleeding.
