Monomorphic ventricular tachycardia after intentional citalopram overdose

A 19-year-old man arrived at the emergency department via ambulance after ingesting a large dose of citalopram at an unknown time in a self-harm attempt. The patient presented with altered mental status (nonsensical 1-word answers to questions), profound nystagmus, tremor, hyperreflexia, tachycardia, and hyperthermia. Electrocardiogram evaluation revealed a prolonged QRS with a right bundle-branch block pattern and intermittent monomorphic ventricular tachycardia (MVT). The patient was treated with sodium bicarbonate boluses, magnesium, and lidocaine with subsequent resolution of his electrocardiogram abnormalities. His serotonergic symptoms (tremor, hyperreflexia, and hyperthermia) were treated with intubation, paralysis, and sedation with benzodiazepines. The patient was continued on a lidocaine drip for 24 hours with no recurrence of his right bundle-branch block or MVT. Although QRS prolongation, QT prolongation, and polymorphic ventricular tachycardia have been reported with citalopram overdose, this is the first reported case of citalopram-associated MVT.
Source: The American Journal of Emergency Medicine - Category: Emergency Medicine Authors: Tags: Case Reports Source Type: research