Abstract
Atypical antipsychotics like quetiapine cause few extrapyramidal adverse effects. Used prominently in psychiatry, these drugs are increasingly used by emergency patients to intentionally overdose. A psychiatric outpatient in her 40s presented with hemodynamic instability as well as impaired consciousness and generalized tonic seizures. The patient came in with empty blister packs, suggesting she had taken a massive dose of quetiapine (8,700 mg). The dose taken was presumed to be toxic, and initial treatment involved gastric lavage and activated charcoal. The patient received fluid therapy and respiratory and circulatory care in the intensive care unit; the patient's level of consciousness and general condition improved on day 3 of hospitalization, so the patient was discharged. Biological specimens such as serum and urine were cryopreserved, allowing retrospective analysis. In a clinical setting like a general hospital, acute poisoning is normally suspected because of results of a simple urine drug screening kit and a history of medication, but a kit may fail to detect quetiapine. Quetiapine is a new drug and has reportedly caused deaths in Japan and abroad. An analysis that reveals quetiapine may lead to a definitive diagnosis of quetiapine poisoning, and a prompt diagnosis should help in guiding treatment.
