Other, pp.27-28, 2007
ntroduction:Childhood depression is seen mostly in adolescence and canlead to suicide. Suicide cases generally are in the form of drug intoxication.Here, we present a girl with Wolf Parkinson White (WPW) syndrometaking overdose of citalopram, a frequently used selective serotoninreuptake inhibitor, which was prescribed for depression. Changes onelectrocardiography (ECG) were documented.Methods:A 15-year-old girl was admitted to the emergency departmentbecause of taking high dose of citalopram (720 mg). After activatedcharcoal administration and performing gastric lavage, she washospitalized. Because of the prolongation of QRS complex andcorrected QT interval (QTc), she was consulted to pediatric cardiologydepartment. The ECG revealed that heart rate was 72/min, PRinterval was 0.10 milliseconds, QRS complex was wide (0.14 msn),and there was delta wave at the beginning of the QRS complex.On Holter monitorization, there were attacks of sinus tachycardia,which could not be differentiated from supraventricular tachycardia.NaHCO3 infusion, an agent used to normalize the electrocardiographicchanges due to citalopram, was performed. NaHCO3 (50 mEq)intravenous bolus and NaHCO3 (150 mEq) intravenous infusion(75 mL/h) were given. ECG analysis was performed to show thechanges (Table 1).Results:Citalopram’s cardiotoxic metabolite, didesmethylcitalopram,prolongs the QTc and causes fatal arrhythmias. Doses greater than600 mg cause ECG abnormalities like prolongation of the QTcinterval and the QRS complex, nonspecific ST-T changes, and sinustachycardia. These ECG changes increase the risk of arrhythmia. Inthe present case, there were prolongations of QRS complex and QTc.These are seen also in WPW syndrome and/or with citalopramintoxication. The JTc, in order not to see the effect of preexcitationand to see the effect of NaHCO3 independently, was also analyzed. Ascitalopram is a lipophilic compound, the QRS, QTc, and JTc periodsprogressively increased. After NaHCO3 treatment, progressive decreasewas documented.
Conclusions:Here, we showed the effects of citalopram and NaHCO3on ECG. We also showed that NaHCO3 can also be used for patientswith WPW syndrome for resolving ECG changes due to citalopramintoxication