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Adult respiratory distress syndrome and renal failure associated with citalopram overdose

Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SU, UK; cathy.kelly{at}luht.scot.nhs.uk

A Upex

Scottish Poisons Information Bureau, Royal Infirmary, Edinburgh, UK

E P Spencer

R J Flanagan

Medical Toxicology Unit, Guy's and St Thomas's Hospital Trust, Avonley Road, London, UK

D N Bateman

Scottish Poisons Information Bureau, Royal Infirmary, Edinburgh, UK

A 45-year-old man ingested 3000 mg of citalopram hydrobromide (2400 mg citalopram). He presented to the Emergency Department 2 hours post-ingestion with a pulse of 100 beats/min and blood pressure of 120/ 80 mmHg. His electrocardiogram (ECG) was normal. Chest X-ray showed bilateral shadowing, with no evidence of aspiration of gastric contents. Shortly after, he had three tonic-clonic seizures, requiring intravenous diazepam. Eight hours post-ingestion he became oliguric with deteriorating renal function, despite normal arterial and central venous pressures. He became increasingly hypoxic, with chest X-ray changes compatible with adult respiratory distress syndrome (ARDS). Despite treatment with 100% oxygen and continuous positive airway pressure, his gas exchange continued to deteriorate, requiring intubation and ventilation. His renal function also deteriorated with a peak creatinine of 492 mmol/L on day 4 in the absence of rhabdomyolysis. There was complete spontaneous recovery of renal function after 2 weeks. A peak plasma total citalopram (R-S enantiomers) concentration of 1.92 mg/L was recorded 2 hours post-ingestion. Total norcitalopram concentrations continued to rise up to 24 hours post-ingestion. Citalopram has been associated with seizures, ECG abnormalities, rhabdomyolysis and coma after overdose. The renal and respiratory complications seen in this patient have not been reported previously.

Key Words: acute lung injury • adult respiratory distress syndrome • citalopram • renal failure

Human & Experimental Toxicology, Vol. 22, No. 2, 103-105 (2003)
DOI: 10.1191/0960327103ht327cr


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