Pediatria Clínica: Acesso Aberto
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Atypical Antipsychotic Toxidrome: A Case Report and a Proposed New Toxicity Syndrome

Hanna S. Sahhar*, Maichoua S. Lor, Lauren Bailey

Quetiapine is an atypical antipsychotic medication approved by the U.S. Food and Drug Administration to treat psychosis and mood disorders. Side effects of quetiapine when used at therapeutic levels include sedation, weight gain, and orthostatic hypotension. Quetiapine toxicity in overdose or misuse presents with autonomic instability, miosis, hypotension, extrapyramidal symptoms, and QTc interval prolongation. We present a unique case of an unsuspected quetiapine overdose in a 17-year-old male with comorbid untreated epilepsy. The patient presented with acute dystonia, central nervous system depression, and miosis. The patient required endotracheal intubation and mechanical ventilation and was treated with supportive care. He subsequently developed neuroleptic malignant syndrome and aspiration pneumonia. The patient recovered completely without residual symptoms. We propose that atypical antipsychotic toxicity should be recognized as a toxidrome category for pediatric and adolescent patients.