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Hypothermia in a combined intoxication with doxepin and moclobemide in an adolescent.

Author(s): Armbrust S, Nikischin W, Rochholz G, Franzelius C, Bielstein A, Kramer HH

Affiliation(s): Department of Pediatric Cardiology, University Children's Hospital, Kiel, Germany. armbrust@pedcard.uni-kiel.de

Publication date & source: 2010-02-25, Forensic Sci Int., 195(1-3):e1-3. Epub 2010 Jan 13.

Publication type: Case Reports

OBJECTIVE: Intoxication with antidepressants, frequently encountered in pediatric emergency medicine, can often lead to life threatening situations. While hyperthermia, hypertonicity and rigidity are symptoms indicative of a serotonin syndrome triggered by an intoxication with serotonin reuptake inhibitors or monoamine oxidase inhibitors, cardiotoxicity, coma and ECG changes are typical of an intoxication with tricyclic antidepressants. CASE REPORT: Hypothermia (instead of the expected hyperthermia) is described for the first time as a persistent symptom during the course of a combined moclobemide-doxepin intoxication in an attempted suicide of a 16-year-old adolescent. DISCUSSION: The administration of serotonin reuptake inhibitors alone or in combination with other medication which increases the level of 5-hydroxytryptamine, i.e. serotonin, in the synaptic cleft mainly leads to hyperthermia. According to a recent study, however, the application of a selective 5-HT(1a) agonist to transgenic mice with a prominent overexpression of the 5-HT(1a) receptor lead to immobility and hypothermia. These findings might help to explain the hypothermia observed in the case of the intoxicated 16-year-old. CONCLUSION: Intoxication with antidepressants should not be excluded a priori in a hypothermic patient who displays other clinical signs of the said intoxication. 2009. Published by Elsevier Ireland Ltd.

Page last updated: 2010-10-05

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