Accidental clozapine intoxication in a toddler: clinical and pharmacokinetic lessons learnt
2012; Wiley; Volume: 38; Issue: 2 Linguagem: Inglês
10.1111/jcpt.12022
ISSN1365-2710
AutoresNicole Toepfner, Ariane Wohlfarth, Jana Naue, Volker Auwärter, Reinhard Berner, Maren Hermanns‐Clausen,
Tópico(s)Epilepsy research and treatment
ResumoJournal of Clinical Pharmacy and TherapeuticsVolume 38, Issue 2 p. 165-168 Case Report Accidental clozapine intoxication in a toddler: clinical and pharmacokinetic lessons learnt N. Toepfner MD, N. Toepfner MD Clinic and Polyclinic for Pediatrics and Adolescent Medicine, Carl Gustav Carus University, DresdenSearch for more papers by this authorA. Wohlfarth PhD, A. Wohlfarth PhD National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USASearch for more papers by this authorJ. Naue, J. Naue Institute of Forensic Medicine, University Medical Center, FreiburgSearch for more papers by this authorV. Auwärter PhD, V. Auwärter PhD Institute of Forensic Medicine, University Medical Center, FreiburgSearch for more papers by this authorR. Berner MD, R. Berner MD Clinic and Polyclinic for Pediatrics and Adolescent Medicine, Carl Gustav Carus University, DresdenSearch for more papers by this authorM. Hermanns-Clausen MD, M. Hermanns-Clausen MD Poison Information Center VIZ-Freiburg, University Medical Center, Freiburg, GermanySearch for more papers by this author N. Toepfner MD, N. Toepfner MD Clinic and Polyclinic for Pediatrics and Adolescent Medicine, Carl Gustav Carus University, DresdenSearch for more papers by this authorA. Wohlfarth PhD, A. Wohlfarth PhD National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USASearch for more papers by this authorJ. Naue, J. Naue Institute of Forensic Medicine, University Medical Center, FreiburgSearch for more papers by this authorV. Auwärter PhD, V. Auwärter PhD Institute of Forensic Medicine, University Medical Center, FreiburgSearch for more papers by this authorR. Berner MD, R. Berner MD Clinic and Polyclinic for Pediatrics and Adolescent Medicine, Carl Gustav Carus University, DresdenSearch for more papers by this authorM. Hermanns-Clausen MD, M. Hermanns-Clausen MD Poison Information Center VIZ-Freiburg, University Medical Center, Freiburg, GermanySearch for more papers by this author First published: 20 November 2012 https://doi.org/10.1111/jcpt.12022Citations: 7 N. Toepfner, Clinic and Polyclinic for Pediatrics and Adolescent Medicine, Carl Gustav Carus University, Fetscherstraße 74, Dresden 01307, Germany. Tel.: +49 (0)351 458 18715; fax: +49 (0)351 458 4384; e-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Summary What is known and Objective: Clozapine, a second generation antipsychotic which is relatively safe in overdose, has been used as an effective treatment alternative to traditional antipsychotics. The therapeutic use in children remains controversial. However, in accordance with the increasing prescription in adults, the accidental ingestion in childhood becomes more frequent. We report the youngest case of accidental clozapine ingestion. Case summary: A 13-month-old girl presented with acute respiratory insufficiency and coma of unknown origin. The medical history, laboratory and radiological assessment did not link to aetiology until an almost spontaneous arousal after 22 h pointed towards intoxication. The initial standard drug screening using immunoassay had been negative. Hence, liquid chromatography mass spectrometry/mass spectrometry (LC-MS/MS) was performed, and clozapine was detected with a serum concentration of 736 ng/mL. What is new and Conclusion: This case illustrates the diagnostic and forensic pitfalls in a coma of unknown origin due to the limits of toxicological screening immunoassays. LC-MS/MS analysis by an established method showed clozapine metabolites (norclozapine and clozapine-N-oxide) are detectable for longer period, especially in urine, when compared with clozapine. The clinical course is presented in unique correlation with plasma and urine concentrations of clozapine and its metabolites. The elimination pattern of clozapine in toddlers is similar to adults, and the toxic dose was found to be lower when compared with school-age children and adults. Citing Literature Volume38, Issue2April 2013Pages 165-168 RelatedInformation
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