SCCM Resource Library-The Serotonin Saga: When Venlafaxine Unleashed Chaos and ARDS

Pdf Summary

This document details a clinical case of a 52-year-old female who presented with an intentional overdose of venlafaxine, taking approximately 30 tablets. Upon arrival at the emergency department, the patient demonstrated seizure-like activity and airway compromise, requiring immediate intubation and ICU admission. The management included mechanical ventilation, correction of metabolic and respiratory acidosis, and continuous EKG monitoring due to QTc prolongation and clonic posturing. <br /><br />Two days post-admission, the patient's oxygenation worsened, with a PF ratio dropping to 100. Chest X-rays revealed bilateral ground-glass opacities indicating the development of Acute Respiratory Distress Syndrome (ARDS). Interventions included positioning the patient in a prone position for 16 hours and using low tidal volume ventilation, which improved oxygenation. The patient was successfully extubated after six days and transferred for psychiatric care.<br /><br />The discussion highlights serotonin syndrome as a known adverse effect of SSRIs and more significantly with SNRIs, such as venlafaxine. The presented case is indicative of typical venlafaxine toxicity symptoms, including seizures, cognitive changes, and clonus. Although there is documented evidence of SSRIs like citalopram leading to serotonin syndrome and subsequent ARDS, there is limited literature specifically linking venlafaxine to ARDS. The case underscores the need for clinicians to maintain a high index of suspicion for serotonin syndrome and its potential severe respiratory complications to ensure timely diagnosis and intervention.<br /><br />References provided include case studies and articles on similar presentations of serotonin syndrome leading to pulmonary complications, underscoring the clinical relevance of the described case.

Asset Subtitle

Pulmonary, 2023, 0:10:00

Asset Caption

Case study on serotonin syndrome

Meta Tag

Content Type Critical Care Quick Study

Knowledge Area Pulmonary

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Acute Respiratory Distress Syndrome ARDS

Year 2023

Keywords

venlafaxine overdose

seizure-like activity

intubation

ICU admission

QTc prolongation

ARDS

serotonin syndrome

SNRIs

pulmonary complications

psychiatric care

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