Arrhythmias in Severe Trazodone Overdose

Patient: Female, 55-year-old Final Diagnosis: Trazodone overdose Symptoms: Altered mental status • seizure • shock • arrhythmia Medication: — Clinical Procedure: — Specialty: Toxicology OBJECTIVE: Rare disease BACKGROUND: Trazodone is widely used in the treatment of depression, anxiety, and insomnia. It is thought to have a safe cardiac profile due to the relative lack of anticholinergic effects. Publications about cardiac toxicities of trazodone are scant. CASE REPORT: A 55-year-old woman presented with acute disorder of consciousness secondary to an intentional trazodone overdose. She was found to have seizure activity without cerebral edema. The initial electrocardiogram was unremarkable, with a normal QTc interval. She eventually developed QTc prolongation that evolved into ventricular tachycardia, and then into a transient right bundle-branch block, left anterior fascicular block, and variable degrees of atrioventricular nodal blocks at 12–24 h after ingestion. She then developed generalized tonic-clonic seizures, cardiogenic shock, and respiratory arrest. She was intubated and treated with antiepileptics, norepinephrine, and dopamine infusion. QTc interval prolongation gradually resolved and the various forms of heart block did not recur after at 24–36 h. She did not require transcutaneous pacing, and was successfully extubated with intact neurological function. CONCLUSIONS: Fatal arrhythmias can occur in trazodone overdose. Close monitoring and supportive care are crucial for patient survival.