Refractory toxicity of atypical antipsychotics

Q: Which of the following is a choice of treatment in refractory cases of toxicity from atypical antipsychotics?

A) Hemodialysis (HD)
B) Continuous Renal Replacement Therapy (CRRT)
C) Bicarbonate infusion
D) Lipid emulsion therapy
E) Hyperbaric oxygen


Answer: D

Although evidence is weak but lipid emulsion therapy is the only known effective treatment for refractory toxicity from atypical antipsychotics.

Unlike most drug overdoses HD and CRRT are not effective and so far has no role in such clinical scenarios.

Bicarbonate is an effective treatment for tricyclic antidepressants overdose but not for an overdose of atypical antipsychotics.

Using hyperbaric oxygen would be a malpractice!


References:

1. Bartos M, Knudsen K. Use of intravenous lipid emulsion in the resuscitation of a patient with cardiovascular collapse after a severe overdose of quetiapine. Clin Toxicol (Phila) 2013; 51:501.

2. Yurtlu BS, Hanci V, Gür A, Turan IO. Intravenous lipid infusion restores consciousness associated with olanzapine overdose. Anesth Analg 2012; 114:914.