Rhabdomyolysis as a manifestation of clomipramine poisoning

São Paulo Medical Journal = Revista Paulista De Medicina
Nathalie Oliveira de Santana, Aécio Flávio Teixeira de Góis

Abstract

Tricyclic antidepressive agents are widely used in suicide attempts and present a variety of deleterious effects. Rhabdomyolysis is a rare complication of such poisoning. A 55-year-old woman ingested 120 pills of 25 mg clomipramine in a suicide attempt two days before admission. After gastric lavage in another emergency department on the day of intake, 80 pills were removed. On admission to our department, she was disoriented, complaining of a dry mouth and tremors at the extremities. An electrocardiogram showed a sinus rhythm with narrow QRS complexes. Laboratory results showed high creatine phosphokinase (CK = 15,094 U/l on admission; normal range = 26 to 140 U/l), hypocalcemia, slightly increased serum transaminases and mild metabolic acidosis. The patient's medical history included depression with previous suicide attempts, obsessive-compulsive disorder, hypothyroidism and osteoporosis. She presented cardiac arrest with pulseless electric activity for seven minutes and afterwards, without sedation, showed continuous side-to-side eye movement. She developed refractory hypotension, with need for vasopressors. Ceftriaxone and clindamycin administration was started because of a hypothesis of bronchoaspiration. The patient remai...Continue Reading

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Citations

Feb 28, 2019·Journal of Medical Case Reports·Stephan von DüringLaurent Christin
Jul 2, 2016·Proceedings·Chibuzo Clement OdigweNkemakolam Iroegbu
Oct 28, 2021·Journal of Psychopharmacology·Tian LanGuo-Xin Hu
Oct 29, 2021·Internal Medicine·Shohei ObayashiYoko Ito

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