Quetiapine overdose

predicting intubation, duration of ventilation, cardiac monitoring and the effect of activated charcoal

Geoffrey Isbister, S DUFFULL

Research output: Contribution to journalArticleResearchpeer-review

Abstract

To investigate factors that predict the probability and duration of mechanical ventilation in quetiapine overdose, and if cardiac toxicity occurs, this cohort study involved 176 patients presenting to a toxicology unit on 286 occasions with quetiapine overdose. Patient demographics, dose, coingestants, single dose activated charcoal (SDAC) administration, requirement for and duration of mechanical ventilation and electrocardiogram parameters (heart rate, QT, QRS) were obtained. A fully Bayesian approach using logistic regression and time-to-event analysis was undertaken to investigate the relationship between predictor variables and the requirement for and duration of intubation. QT versus heart rate was plotted on a QT nomogram to investigate QT prolongation. The commonest clinical effects were central nervous system depression on 136 occasions (48%) and tachycardia (67%). There were no malignant arrhythmias and an abnormal QT occurred in only 24 admissions (8.4%), all with tachycardia. Hypotension (systolic blood pressure <90 mmHg) occurred on 35 occasions (12%). The logistic regression model supported dose and SDAC (<2 h) influencing the probability of intubation, but not age, sex, therapeutic use of quetiapine or coingestants. The probability of intubation was 10% after 2 g, 22% after 5 g, 37% after 10 g and 55% after 20 g and SDAC resulted in a reduced probability of intubation of 7% for 2 g ingestion. The edian duration of ventilation was 22 h (interquartile: 19-28 h), which was not affected by SDAC. Ingested dose can inform early decision making about requirements for intensive care unit admission and intubation. SDAC seems to have only modest effects on outcomes but may be considered within 2 h for large ingestions. Electrocardiogram monitoring is unlikely to be necessary. � 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Original languageEnglish
Pages (from-to)174-180
Number of pages7
JournalInternational Clinical Psychopharmacology
Volume24
Issue number4
Publication statusPublished - 2009

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Charcoal
Intubation
Ventilation
Logistic Models
Artificial Respiration
Tachycardia
Electrocardiography
Eating
Heart Rate
Blood Pressure
Nomograms
Bayes Theorem
Therapeutic Uses
Hypotension
Toxicology
Intensive Care Units
Cardiac Arrhythmias
Decision Making
Cohort Studies
Central Nervous System

Cite this

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title = "Quetiapine overdose: predicting intubation, duration of ventilation, cardiac monitoring and the effect of activated charcoal",
abstract = "To investigate factors that predict the probability and duration of mechanical ventilation in quetiapine overdose, and if cardiac toxicity occurs, this cohort study involved 176 patients presenting to a toxicology unit on 286 occasions with quetiapine overdose. Patient demographics, dose, coingestants, single dose activated charcoal (SDAC) administration, requirement for and duration of mechanical ventilation and electrocardiogram parameters (heart rate, QT, QRS) were obtained. A fully Bayesian approach using logistic regression and time-to-event analysis was undertaken to investigate the relationship between predictor variables and the requirement for and duration of intubation. QT versus heart rate was plotted on a QT nomogram to investigate QT prolongation. The commonest clinical effects were central nervous system depression on 136 occasions (48{\%}) and tachycardia (67{\%}). There were no malignant arrhythmias and an abnormal QT occurred in only 24 admissions (8.4{\%}), all with tachycardia. Hypotension (systolic blood pressure <90 mmHg) occurred on 35 occasions (12{\%}). The logistic regression model supported dose and SDAC (<2 h) influencing the probability of intubation, but not age, sex, therapeutic use of quetiapine or coingestants. The probability of intubation was 10{\%} after 2 g, 22{\%} after 5 g, 37{\%} after 10 g and 55{\%} after 20 g and SDAC resulted in a reduced probability of intubation of 7{\%} for 2 g ingestion. The edian duration of ventilation was 22 h (interquartile: 19-28 h), which was not affected by SDAC. Ingested dose can inform early decision making about requirements for intensive care unit admission and intubation. SDAC seems to have only modest effects on outcomes but may be considered within 2 h for large ingestions. Electrocardiogram monitoring is unlikely to be necessary. � 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.",
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Quetiapine overdose : predicting intubation, duration of ventilation, cardiac monitoring and the effect of activated charcoal. / Isbister, Geoffrey; DUFFULL, S.

In: International Clinical Psychopharmacology, Vol. 24, No. 4, 2009, p. 174-180.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Quetiapine overdose

T2 - predicting intubation, duration of ventilation, cardiac monitoring and the effect of activated charcoal

AU - Isbister, Geoffrey

AU - DUFFULL, S

PY - 2009

Y1 - 2009

N2 - To investigate factors that predict the probability and duration of mechanical ventilation in quetiapine overdose, and if cardiac toxicity occurs, this cohort study involved 176 patients presenting to a toxicology unit on 286 occasions with quetiapine overdose. Patient demographics, dose, coingestants, single dose activated charcoal (SDAC) administration, requirement for and duration of mechanical ventilation and electrocardiogram parameters (heart rate, QT, QRS) were obtained. A fully Bayesian approach using logistic regression and time-to-event analysis was undertaken to investigate the relationship between predictor variables and the requirement for and duration of intubation. QT versus heart rate was plotted on a QT nomogram to investigate QT prolongation. The commonest clinical effects were central nervous system depression on 136 occasions (48%) and tachycardia (67%). There were no malignant arrhythmias and an abnormal QT occurred in only 24 admissions (8.4%), all with tachycardia. Hypotension (systolic blood pressure <90 mmHg) occurred on 35 occasions (12%). The logistic regression model supported dose and SDAC (<2 h) influencing the probability of intubation, but not age, sex, therapeutic use of quetiapine or coingestants. The probability of intubation was 10% after 2 g, 22% after 5 g, 37% after 10 g and 55% after 20 g and SDAC resulted in a reduced probability of intubation of 7% for 2 g ingestion. The edian duration of ventilation was 22 h (interquartile: 19-28 h), which was not affected by SDAC. Ingested dose can inform early decision making about requirements for intensive care unit admission and intubation. SDAC seems to have only modest effects on outcomes but may be considered within 2 h for large ingestions. Electrocardiogram monitoring is unlikely to be necessary. � 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.

AB - To investigate factors that predict the probability and duration of mechanical ventilation in quetiapine overdose, and if cardiac toxicity occurs, this cohort study involved 176 patients presenting to a toxicology unit on 286 occasions with quetiapine overdose. Patient demographics, dose, coingestants, single dose activated charcoal (SDAC) administration, requirement for and duration of mechanical ventilation and electrocardiogram parameters (heart rate, QT, QRS) were obtained. A fully Bayesian approach using logistic regression and time-to-event analysis was undertaken to investigate the relationship between predictor variables and the requirement for and duration of intubation. QT versus heart rate was plotted on a QT nomogram to investigate QT prolongation. The commonest clinical effects were central nervous system depression on 136 occasions (48%) and tachycardia (67%). There were no malignant arrhythmias and an abnormal QT occurred in only 24 admissions (8.4%), all with tachycardia. Hypotension (systolic blood pressure <90 mmHg) occurred on 35 occasions (12%). The logistic regression model supported dose and SDAC (<2 h) influencing the probability of intubation, but not age, sex, therapeutic use of quetiapine or coingestants. The probability of intubation was 10% after 2 g, 22% after 5 g, 37% after 10 g and 55% after 20 g and SDAC resulted in a reduced probability of intubation of 7% for 2 g ingestion. The edian duration of ventilation was 22 h (interquartile: 19-28 h), which was not affected by SDAC. Ingested dose can inform early decision making about requirements for intensive care unit admission and intubation. SDAC seems to have only modest effects on outcomes but may be considered within 2 h for large ingestions. Electrocardiogram monitoring is unlikely to be necessary. � 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.

KW - activated carbon

KW - anticonvulsive agent

KW - citalopram

KW - neuroleptic agent

KW - quetiapine

KW - sedative agent

KW - valproic acid

KW - adult

KW - article

KW - artificial ventilation

KW - Bayes theorem

KW - cardiotoxicity

KW - central nervous system depression

KW - clinical decision making

KW - cohort analysis

KW - drug overdose

KW - electrocardiogram

KW - endotracheal intubation

KW - female

KW - heart rate

KW - human

KW - hypotension

KW - intensive care unit

KW - logistic regression analysis

KW - major clinical study

KW - male

KW - monitoring

KW - priority journal

KW - QRS complex

KW - QT interval

KW - QT prolongation

KW - systolic blood pressure

KW - tachycardia

KW - treatment outcome

KW - Adult

KW - Antipsychotic Agents

KW - Cardiovascular Diseases

KW - Charcoal

KW - Cohort Studies

KW - Dibenzothiazepines

KW - Drug Interactions

KW - Female

KW - Humans

KW - Intubation, Intratracheal

KW - Male

KW - Models, Statistical

KW - Overdose

KW - Respiration, Artificial

KW - Time Factors

M3 - Article

VL - 24

SP - 174

EP - 180

JO - International Clinical Psychopharmacology

JF - International Clinical Psychopharmacology

SN - 0268-1315

IS - 4

ER -