Serotonin syndrome following sibutramine poisoning in a child, with sequential quantification of sibutramine and its primary and secondary amine metabolites in plasma

Objective. To report a case of serotonin syndrome (SS) after sibutramine overdose in a child. Case report. A 4-year-old girl was admitted 25 h after accidentally ingesting approximately 27 pills of sibutramine (15 mg, ∼23 mg kg). The child developed clinical features suggestive of SS, including diap...

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Published in:	Clinical toxicology (Philadelphia, Pa.) Vol. 47; no. 6; pp. 598 - 601
Main Authors:	Bucaretchi, Fábio, de Capitani, Eduardo Mello, Mello, Sueli Moreira, Lanaro, Rafael, Barros, Roberta F., Fernandes, Luciane C.R., Costa, JosÉ Luiz DA, Hyslop, Stephen
Format:	Journal Article
Language:	English
Published:	Philadelphia, PA Informa UK Ltd 01-07-2009 Taylor & Francis
Subjects:	Antidotes - administration & dosage Appetite Depressants - analysis Appetite Depressants - poisoning Biological and medical sciences Child, Preschool Chloral Hydrate - administration & dosage Chromatography, High Pressure Liquid Creatine Kinase - blood Cyclobutanes - blood Cyclobutanes - poisoning Di-desmethyl sibutramine Diazepam - administration & dosage Drug intoxications. Doping Drug Overdose - therapy Female Humans Medical sciences Midazolam - administration & dosage Mono-desmethyl sibutramine Pediatric Pharmacology. Drug treatments Serotonin syndrome Serotonin Syndrome - chemically induced Serotonin Syndrome - physiopathology Serotonin Syndrome - therapy Sibutramine Spectrometry, Mass, Electrospray Ionization South America Brazil America Human Pediatrics Secondary Serotonin Metabolite Drug intoxication Di-desmethyl sibutramine Sibutramine Catecholamine Reuptake inhibitor Blood plasma Case study Serotonin syndrome Accident Neurotransmitter Norepinephrine Anorectic Primary amine Child Pediatric Quantitative analysis Mono-desmethyl sibutramine
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Summary:	Objective. To report a case of serotonin syndrome (SS) after sibutramine overdose in a child. Case report. A 4-year-old girl was admitted 25 h after accidentally ingesting approximately 27 pills of sibutramine (15 mg, ∼23 mg kg). The child developed clinical features suggestive of SS, including diaphoresis, tachycardia, hypertension, agitation, insomnia, incoordination, hypertonia (lower limbs > upper limbs), and hallucinations. Serum creatine phosphokinase levels reached a peak on day 3 (2,577 U L, reference value <145), suggesting mild rhabdomyolysis. No relevant changes were detected in other laboratory examinations or in the electrocardiogram throughout the period of hospitalization. The quantification of sibutramine and the active metabolites, M1 (mono-desmethyl sibutramine) and M2 (di-desmethyl sibutramine), by liquid chromatography electrospray ionization tandem mass spectrometry in six sequential samples collected from 25 to 147 h post-ingestion revealed a nonlinear decrease in the log-scale plasma concentrations. Treatment was only supportive and involved prolonged sedation to control the agitation, sleeplessness, and hypertension; no cyproheptadine was used. The patient was discharged on day 6 and follow-up revealed no sequelae. Conclusion. To our knowledge, this is the first report of SS after sibutramine overdose in a child, with sequential monitoring of the plasma levels of the drug and its two active metabolites. The growing consumption of weight reducing pills may increase the risk of unintentional acute toxic exposures in children.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	1556-3650 1556-9519
DOI:	10.1080/15563650903018603