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Sodium channel blockade with QRS widening after an escitalopram overdose.
Pediatr Emerg Care. 2013 Sep; 29(9):998-1001.PE

Abstract

INTRODUCTION

Escitalopram is rarely associated with prolongation of the QTc interval; however, there are no reported cases of QRS complex widening associated with escitalopram overdose. We report a case of a patient who presented with both QRS complex widening and QTc interval prolongation after an escitalopram overdose.

CASE

A 16-year-old girl presented to the emergency department after ingestion of escitalopram, tramadol/acetaminophen, and hydrocodone/acetaminophen. Laboratory results were significant for 4-hour acetaminophen 21.1 μg/mL. Serum electrolytes including potassium, magnesium, and calcium were all normal. Initial electrocardiogram (ECG) revealed a widened QRS with an incomplete right bundle branch pattern. After administration of 100-mEq sodium bicarbonate, a repeat ECG revealed narrowing of the QRS complex and a prolonged QTc interval. Magnesium sulfate 2 g intravenous and sodium bicarbonate drip were initiated. A repeat ECG, 1 hour after the second, revealed normalization of the QRS complex and QTc interval.

DISCUSSION

Prolongation of the QTc interval is an expected effect of escitalopram. Both escitalopram and citalopram are metabolized to the cardiotoxic metabolite S-didesmethylcitalopram and didesmethylcitalopram, respectively, which have been implicated in numerous cardiac abnormalities including widening of the QRS complex. Although never previously described with escitalopram, this mechanism provides a reasonable explanation for the QRS complex widening and incomplete right bundle branch block that occurred in our patient.

CONCLUSIONS

Both QRS complex widening and QTc interval prolongation should be monitored in cases of escitalopram and citalopram overdoses.

Authors+Show Affiliations

From the Department of Emergency Medicine, Upstate Medical University, Syracuse NY.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

24201980

Citation

Schreffler, Susan M., et al. "Sodium Channel Blockade With QRS Widening After an Escitalopram Overdose." Pediatric Emergency Care, vol. 29, no. 9, 2013, pp. 998-1001.
Schreffler SM, Marraffa JM, Stork CM, et al. Sodium channel blockade with QRS widening after an escitalopram overdose. Pediatr Emerg Care. 2013;29(9):998-1001.
Schreffler, S. M., Marraffa, J. M., Stork, C. M., & Mackey, J. (2013). Sodium channel blockade with QRS widening after an escitalopram overdose. Pediatric Emergency Care, 29(9), 998-1001. https://doi.org/10.1097/PEC.0b013e3182a314b7
Schreffler SM, et al. Sodium Channel Blockade With QRS Widening After an Escitalopram Overdose. Pediatr Emerg Care. 2013;29(9):998-1001. PubMed PMID: 24201980.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sodium channel blockade with QRS widening after an escitalopram overdose. AU - Schreffler,Susan M, AU - Marraffa,Jeanna M, AU - Stork,Christine M, AU - Mackey,Jennifer, PY - 2013/11/9/entrez PY - 2013/11/10/pubmed PY - 2014/7/16/medline SP - 998 EP - 1001 JF - Pediatric emergency care JO - Pediatr Emerg Care VL - 29 IS - 9 N2 - INTRODUCTION: Escitalopram is rarely associated with prolongation of the QTc interval; however, there are no reported cases of QRS complex widening associated with escitalopram overdose. We report a case of a patient who presented with both QRS complex widening and QTc interval prolongation after an escitalopram overdose. CASE: A 16-year-old girl presented to the emergency department after ingestion of escitalopram, tramadol/acetaminophen, and hydrocodone/acetaminophen. Laboratory results were significant for 4-hour acetaminophen 21.1 μg/mL. Serum electrolytes including potassium, magnesium, and calcium were all normal. Initial electrocardiogram (ECG) revealed a widened QRS with an incomplete right bundle branch pattern. After administration of 100-mEq sodium bicarbonate, a repeat ECG revealed narrowing of the QRS complex and a prolonged QTc interval. Magnesium sulfate 2 g intravenous and sodium bicarbonate drip were initiated. A repeat ECG, 1 hour after the second, revealed normalization of the QRS complex and QTc interval. DISCUSSION: Prolongation of the QTc interval is an expected effect of escitalopram. Both escitalopram and citalopram are metabolized to the cardiotoxic metabolite S-didesmethylcitalopram and didesmethylcitalopram, respectively, which have been implicated in numerous cardiac abnormalities including widening of the QRS complex. Although never previously described with escitalopram, this mechanism provides a reasonable explanation for the QRS complex widening and incomplete right bundle branch block that occurred in our patient. CONCLUSIONS: Both QRS complex widening and QTc interval prolongation should be monitored in cases of escitalopram and citalopram overdoses. SN - 1535-1815 UR - https://www.unboundmedicine.com/medline/citation/24201980/Sodium_channel_blockade_with_QRS_widening_after_an_escitalopram_overdose_ L2 - http://dx.doi.org/10.1097/PEC.0b013e3182a314b7 DB - PRIME DP - Unbound Medicine ER -