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41 y/o HIV+ took potentially lethal overdose of Seroquel

300mg (approx. 120) tablets. Admitted...
41 y/o HIV+ took potentially lethal overdose of Seroquel 300mg (approx. 120) tablets. Admitted to ER vitals normal then suddenly experienced 3 major seizures within 3-hour period at/before 5pm today (now 10pm), subsequently in coma & non-alert. Blood pressure stable, pulse good. Was on "heavy" dose of sedatives earlier in day, now off. Kidney function normal. Doctor said hemo-something (not hemoglobin) good.
What are the chances subject can experience sudden organ failure (inc. kidney failure), fatal heart arrhythmia, short-term or long-term neurological deficits?
Doctor on-call said watchful waiting only course for now, will take approximately 24-72 hours for all Seroquel to be "flushed out" of body.
Chances for awakening/becoming responsive to stimuli within next 24-28 hours?
Outlook if not responsive within a 72-hour framework?
Doctor who answers all questions 50% tip.
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Answered in 33 minutes by:
5/19/2013
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 36,919
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Greetings.

I am sorry that your question was not answered for quite long.

Seroquel is eliminated in about 42 hours from the body. So this duration would be crucial. But peak plasma levels are achieved at around 2 hours, so in about 6-12 hours, about half of the medication would be excreted from the body and dangers like heart blocks would be reduced. Please read this resource about the pharmacology of Seroquel;

http://reference.medscape.com/drug/seroquel-xr-quetiapine-342984#10


Following are the answers of your questions;

What are the chances subject can experience sudden organ failure (inc. kidney failure), fatal heart arrhythmia, short-term or long-term neurological deficits?

With the convulsions and coma; long term neurological deficits may occur. The exact chance of these complications in an individual cannot be ascertained; as there can be huge variations. But convulsions and coma are not good signs. With a good urine output and stable blood pressure; kidney failure would be not much likely. The major excretion of this drug is from liver and after 24-48 hours; the risk of liver failure too would decrease significantly. Since the pulse rate is good with no irregularity; chance of heart arrhythmia too would decrease in 48 hours.
.
Doctor on-call said watchful waiting only course for now, will take approximately 24-72 hours for all Seroquel to be "flushed out" of body.


Yes, Seroquel is likely to be eliminated in around 42-48 hours.

Chances for awakening/becoming responsive to stimuli within next 24-28 hours?

With coma; chance of awakening in next 24 hours is quite low.

Outlook if not responsive within a 72-hour framework?


If the subject is unresponsive in 72 hours; outlook is not likely to be good and may point to brain insult.

Please read this reference resource;

http://www.rxlist.com/seroquel-drug/overdosage-contraindications.htm


Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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Customer reply replied 4 years ago
Thank you for the excellent answer. I just had a few follow-up questions.
What is your best guess as to the time frame for when patient would awake?
Is there any way to determine whether coma is from seizures or Seroquel overdose or both?
You mentioned if patient is still in come within 72-hour time frame outlook is "not likely to be good." Can you please clarify? What sort of damage might patient experience? Is it possible patient can still regain consciousness after 72-hours? Does risk of significant brain damage increase after 72-hours if patient is still in a coma?
Thank you.
You are very welcome.

What is your best guess as to the time frame for when patient would awake?


This is very difficult question. The answer can only be given after an MRI and EEG.

Is there any way to determine whether coma is from seizures or Seroquel overdose or both?


MRI and EEG can help in giving the answer. The chance is seroquel caused the seizures and that damaged the brain.

You mentioned if patient is still in come within 72-hour time frame outlook is "not likely to be good." Can you please clarify? What sort of damage might patient experience? Is it possible patient can still regain consciousness after 72-hours? Does risk of significant brain damage increase after 72-hours if patient is still in a coma?


More the duration of coma, more is likelihood of significant brain insult. Though the patient can regain consciousness after 72 hours, the chance of irreversible brain damage is almost 25%. The brain damage has already occurred. A persistent coma is not likely to increase the further brain damage.

It is privilege assisting you.
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 36,919
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
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