Sodium channel blockade with QRS widening after an escitalopram overdose.

Abstract:

INTRODUCTION:Escitalopram is rarely associated with prolongation of the QTc interval; however, there are no reported cases of QRS complex widening associated with escitalopram overdose. We report a case of a patient who presented with both QRS complex widening and QTc interval prolongation after an escitalopram overdose. CASE:A 16-year-old girl presented to the emergency department after ingestion of escitalopram, tramadol/acetaminophen, and hydrocodone/acetaminophen. Laboratory results were significant for 4-hour acetaminophen 21.1 μg/mL. Serum electrolytes including potassium, magnesium, and calcium were all normal. Initial electrocardiogram (ECG) revealed a widened QRS with an incomplete right bundle branch pattern. After administration of 100-mEq sodium bicarbonate, a repeat ECG revealed narrowing of the QRS complex and a prolonged QTc interval. Magnesium sulfate 2 g intravenous and sodium bicarbonate drip were initiated. A repeat ECG, 1 hour after the second, revealed normalization of the QRS complex and QTc interval. DISCUSSION:Prolongation of the QTc interval is an expected effect of escitalopram. Both escitalopram and citalopram are metabolized to the cardiotoxic metabolite S-didesmethylcitalopram and didesmethylcitalopram, respectively, which have been implicated in numerous cardiac abnormalities including widening of the QRS complex. Although never previously described with escitalopram, this mechanism provides a reasonable explanation for the QRS complex widening and incomplete right bundle branch block that occurred in our patient. CONCLUSIONS:Both QRS complex widening and QTc interval prolongation should be monitored in cases of escitalopram and citalopram overdoses.

journal_name

Pediatr Emerg Care

journal_title

Pediatric emergency care

authors

Schreffler SM,Marraffa JM,Stork CM,Mackey J

doi

10.1097/PEC.0b013e3182a314b7

subject

Has Abstract

pub_date

2013-09-01 00:00:00

pages

998-1001

issue

9

eissn

0749-5161

issn

1535-1815

pii

00006565-201309000-00009

journal_volume

29

pub_type

杂志文章
  • Utility of Soft Tissue Lateral Neck Radiographs in the Emergency Department: The 5-Year Experience of a Large Tertiary Care Pediatric Hospital.

    abstract:INTRODUCTION:Although retropharyngeal infection (RPI) may present with voice change, drooling, fever, and a toxic appearance, diagnosis based on symptoms alone is unreliable. As incidence is increasing in children and drug-resistant bacterial strains such as methicillin-resistant Staphylococcus aureus are becoming more...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001318

    authors: Sao Pedro T,Scolnik D,Traubici J,Stephens D

    更新日期:2020-05-01 00:00:00

  • Maternal somatic symptoms, psychosocial correlates, and subsequent pediatric emergency department use.

    abstract:BACKGROUND:Somatization is associated with increased health care use in adults. Whether mothers with somatic symptoms use more health care resources for their children has not been investigated. OBJECTIVE:This study aimed to explore the association of maternal somatic symptoms and emergency department (ED) use. DESIG...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e3182809a10

    authors: Dang AT,Ho M,Kroenke K,Grupp-Phelan J

    更新日期:2013-02-01 00:00:00

  • Ultrasound-Guided Posterior Tibial Nerve Block for Plantar Foot Foreign Body Removal.

    abstract::Ultrasound-guided regional anesthesia is a growing modality within the pediatric emergency department. Here we present a case where a posterior tibial nerve block was used for anesthesia during foreign body removal from the plantar foot. We further review the technique and literature regarding this straightforward and...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,评审

    doi:10.1097/PEC.0000000000001897

    authors: Moake MM,Presley BC,Barnes RM

    更新日期:2020-05-01 00:00:00

  • Aspirated safety pin requiring thoracotomy: report of a case and review.

    abstract::Foreign body aspirations in children are relatively uncommon occurrences, but they can be a serious events, causing respiratory distress, atelectasis, chronic pulmonary infections, or death. Safety pins are not commonly aspirated objects and account for less than 3% of all foreign bodies found in the tracheobronchial ...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,评审

    doi:10.1097/00006565-199712000-00011

    authors: Causey AL,Talton DS,Miller RC,Warren ET

    更新日期:1997-12-01 00:00:00

  • Methodology and Demographics of a Brief Adolescent Alcohol Screen Validation Study.

    abstract:OBJECTIVE:The aim of this study was to determine the psychometric properties of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2-question alcohol screen within 16 Pediatric Emergency Care Applied Research Network pediatric emergency departments. This article describes the study methodology, sample chara...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,多中心研究

    doi:10.1097/PEC.0000000000001221

    authors: Bromberg JR,Spirito A,Chun T,Mello MJ,Casper TC,Ahmad F,Bajaj L,Brown KM,Chernick LS,Cohen DM,Fein J,Horeczko T,Levas MN,McAninch B,Monuteaux M,Mull CC,Grupp-Phelan J,Powell EC,Rogers A,Shenoi RP,Suffoletto B,Va

    更新日期:2019-11-01 00:00:00

  • Accidental isopropanol ingestion in children.

    abstract:OBJECTIVE:To describe the clinical course and determine the minimal observation period required following isopropanol ingestion in children. METHODS:The emergency department records of children less than 6 years of age with isopropanol ingestion who presented between June 1992 and December 1998 were identified. Demogr...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-200008000-00005

    authors: Stremski E,Hennes H

    更新日期:2000-08-01 00:00:00

  • Changing epidemiology of injury-related pediatric mortality in a rural state: implications for injury control.

    abstract:STUDY OBJECTIVE:To document the current epidemiology of pediatric injury-related deaths in a rural state and evaluate changes over time. DESIGN:Retrospective review of injury-related deaths in children less than 15 years of age. Data were obtained from death certificates and coroner, autopsy, prehospital, and hospital...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-199812000-00002

    authors: Rausch TK,Sanddal ND,Sanddal TL,Esposito TJ

    更新日期:1998-12-01 00:00:00

  • Occult Pneumothorax Identification on Extended Focused Assessment with Sonography for Trauma Examination in Children.

    abstract:OBJECTIVE:Occult pneumothoraces (OPTXs) are defined by air within the pleural space that is not visible on conventional chest radiographs (CXR). The aim of this study was to understand how frequently the Extended Focused Assessment with Sonography for Trauma (eFAST) examination identifies occult PTX in a pediatric blun...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000002303

    authors: Malek D,Santillanes G,Hsiao V,Mailhot T,Claudius I

    更新日期:2020-12-01 00:00:00

  • Two-Thumb Encircling Technique Over the Head of Patients in the Setting of Lone Rescuer Infant CPR Occurred During Ambulance Transfer: A Crossover Simulation Study.

    abstract:OBJECTIVE:The purpose of this study was to determine if the over-the-head 2-thumb encircling technique (OTTT) provides better overall quality of cardiopulmonary resuscitation compared with conventional 2-finger technique (TFT) for a lone rescuer in the setting of infant cardiac arrest in ambulance. METHODS:Fifty medic...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000833

    authors: Jo CH,Cho GC,Lee CH

    更新日期:2017-07-01 00:00:00

  • Effect of cough and cold medication withdrawal and warning on ingestions by young children reported to Texas poison centers.

    abstract:OBJECTIVE:This study examined whether the withdrawal of over-the-counter cough and cold medication labeled for use in children younger than 2 years in October 2007 and the warning against use of the products in children younger than 4 years in October 2008 affected cough and cold medication ingestions by young children...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,多中心研究

    doi:10.1097/PEC.0b013e3182587b0c

    authors: Forrester MB

    更新日期:2012-06-01 00:00:00

  • Cardiac tamponade presenting as an apparent life-threatening event.

    abstract::The initial emergency department (ED) evaluation of infants with an apparent life-threatening event (ALTE) often fails to identify a definitive cause for the event. Many children that present with an ALTE appear normal by the time they arrive to the ED. These factors can desensitize clinicians into prematurely discoun...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/01.pec.0000159055.49683.cd

    authors: Cousineau A,Savitsky E

    更新日期:2005-02-01 00:00:00

  • Aseptic meningitis from trimethoprim-sulfamethoxazole in an HIV-infected adolescent.

    abstract::Adolescents infected with the human immunodeficiency virus (HIV) often confront the clinician with difficult medical problems. Besides the host of opportunistic infections, which can affect these patients, side effects from medications can be frequent and, at times, life-threatening. We report a case of aseptic mening...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-199706000-00010

    authors: Rudy BJ,Rutstein R

    更新日期:1997-06-01 00:00:00

  • Indications for chest roentgenogram in the febrile young infant.

    abstract::A combined retrospective and prospective analysis of infants 60 days of age or less evaluated for fever (greater than or equal to 38.3 degrees C) or history of fever who received chest roentgenogram over a one-year period was performed to determine whether clinical characteristics were predictive of pneumonia. Of the ...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-198909000-00001

    authors: Losek JD,Kishaba RG,Berens RJ,Bonadio WA,Wells RG

    更新日期:1989-09-01 00:00:00

  • Negative-pressure pulmonary edema: a rare complication of upper airway obstruction in children.

    abstract:UNLABELLED:Negative-pressure pulmonary edema is a rare but life-threatening complication of upper airway obstruction. Because negative-pressure pulmonary edema may occur in a large spectrum of pathologies associated with upper airway obstruction, awareness of this condition is crucial during daily clinical practice. We...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/01.pec.0000186430.92388.a6

    authors: Silva PS,Monteiro Neto H,Andrade MM,Neves CV

    更新日期:2005-11-01 00:00:00

  • Changes in Pediatric-Sized Endotracheal Tube Cuff Pressure With Elevation Gain: Observations in Ex Vivo Simulations and In Vivo Air Medical Transport.

    abstract:OBJECTIVES:Prolonged excessive endotracheal cuff pressure greater than 30 cmH2O is thought to cause ischemic airway injury. Excessive cuff pressure with altitude gain during air medical transport has been previously described in adult patients. It is poorly understood how pediatric-sized endotracheal tube (ETT) cuffs b...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000755

    authors: Long MT,Cvijanovich NZ,McCalla GP,Flori HR

    更新日期:2018-08-01 00:00:00

  • Adverse events in pediatric ketamine sedations with or without morphine pretreatment.

    abstract:OBJECTIVE:To assess outcomes between 2 groups of patients receiving ketamine for procedural sedations in our pediatric emergency department. Our hypothesis is that there is no difference in the number of adverse events in ketamine sedations with and without morphine pretreatment. METHODS:This was a retrospective cohor...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/01.pec.0000221339.26873.14

    authors: Waterman GD Jr,Leder MS,Cohen DM

    更新日期:2006-06-01 00:00:00

  • An infant with trisomy 21 and tachypnea.

    abstract::A 4-month-old infant with trisomy 21 is brought to the emergency department for breathing difficulty. Subsequently, he is diagnosed with a Morgagni diaphragmatic hernia. Tachypnea in an infant with trisomy 21 may be the result of diagnosis such as congenital heart disease, infectious processes, structural anomalies, o...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/01.pec.0000202457.64978.3d

    authors: Marin J,Lopoo J

    更新日期:2006-03-01 00:00:00

  • Esophageal coin with an unusual radiographic appearance.

    abstract::Esophageal coins are typically seen as radiopaque disks on anteroposterior chest radiographs. This radiographic finding is generally considered classic for identifying "swallowed" coins as being in the esophagus. We report the case of an 11-year-old girl with an esophageal coin seen end-on on an anteroposterior chest ...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/01.pec.0000181421.94847.60

    authors: Conners GP,Hadley JA

    更新日期:2005-10-01 00:00:00

  • Sudden unexpected infant death: differentiating natural from abusive causes in the emergency department.

    abstract::Sudden unexpected infant deaths (SUIDs) are deaths in infants younger than 12 months that occur suddenly, unexpectedly, and without obvious cause in the emergency department (ED). Sudden infant death syndrome, the leading cause of SUID in the United States, is much more common, but fatal child abuse and neglect have b...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,评审

    doi:10.1097/PEC.0b013e31826d1e9a

    authors: Bechtel K

    更新日期:2012-10-01 00:00:00

  • Oncology and transport. Beware of the presentation and anticipate the clinical course.

    abstract::These cases demonstrate a few of the presentations that may occur with new onset oncologic problems. While the transport phase of these children's care was not extraordinary, the development and management of the clinical issues might have been influenced by earlier interventions. Would the outcome of Case 1 have been...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-199612000-00019

    authors: Moore KJ,Needle MN

    更新日期:1996-12-01 00:00:00

  • Holiday hazards.

    abstract::Presented is a selective review of the toxicities of various plants, decorations, and miscellaneous items popularly used during the holiday season. Particularly hazardous agents include mistletoe, holly, bubble lights, fireplace flame colors, alkaline batteries, and mothballs. Specific questions regarding management o...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-198512000-00011

    authors: Baker MD

    更新日期:1985-12-01 00:00:00

  • Assessing the Utility of Urine Testing in Febrile Infants 2 to 12 Months of Age With Bronchiolitis.

    abstract:BACKGROUND:The utility of testing for urinary tract infection (UTI) in febrile infants with bronchiolitis is indeterminate. OBJECTIVE:The objective of this study was to investigate if the incidence of UTIs in febrile infants 2 to 12 months of age with bronchiolitis is higher than the presumed incidence of asymptomatic...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001912

    authors: Elkhunovich MA,Wang VJ,Pham P,Arpilleda JC,Clingenpeel JM,Mansour K,Riech T,Yen K,Liu DR

    更新日期:2019-12-03 00:00:00

  • Substance abuse and mental health visits among adolescents presenting to US emergency departments.

    abstract:OBJECTIVES:The objectives of the study were to identify factors associated with adolescent emergency department (ED) visits for substance abuse, including those complicated by mental health (dual diagnosis), and to analyze their effect on ED length of stay (LOS) and disposition. METHODS:We performed a secondary analys...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000421

    authors: Fahimi J,Aurrecoechea A,Anderson E,Herring A,Alter H

    更新日期:2015-05-01 00:00:00

  • Pediatric prehospital evaluation of NYC respiratory arrest survival (PHENYCS).

    abstract:OBJECTIVE:The objective of this study was to describe the demographics, epidemiology, and characteristics associated with survival of children younger than 18 years who had an out-of-hospital respiratory arrest (OOHRA) during a 1-year period in a large urban area. METHODS:A prospective observational cohort of consecut...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e3182675b61

    authors: Tunik MG,Richmond N,Treiber M,Skomorowsky A,Galea S,Vlahov D,Blaney S,Kusick M,Silverman R,Foltin GL

    更新日期:2012-09-01 00:00:00

  • Pediatric EMS transport: are we treating children in a system designed for adults only?

    abstract::Unlike adults, small children and infants do not require stretchers or ambulances for transport from a prehospital scene to the emergency department (ED). This study was designed to determine the importance of this difference in patient transport needs. A Macintosh Classic computer was programmed to compare the time t...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-199202000-00003

    authors: Sacchetti A,Carraccio C,Feder M

    更新日期:1992-02-01 00:00:00

  • Education in the Waiting Room: Description of a Pediatric Emergency Department Educational Initiative.

    abstract:OBJECTIVE:The aim of this study was to understand parents' awareness of and reactions to a slide presentation based waiting-room educational initiative. METHODS:This was a prospective observational study at a Canadian tertiary-care pediatric emergency department (ED) with an annual census of 68,000 visits. An anonymou...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001140

    authors: Reid S,Neto G,Tse S,Farion KJ,Marvizi A,Smith L,Clarkin C,Rohde K,Moreau K

    更新日期:2017-10-01 00:00:00

  • Epidemiology of Headache in Children in a Community Emergency Department: A Scoping Study.

    abstract:OBJECTIVE:This study aimed to describe the epidemiology of headache in children attending a community mixed adult-pediatric emergency department (ED) in Australia with a view to providing scoping data for future headache-related projects for the pediatric ED research networks. METHODS:This is a retrospective cohort st...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000002000

    authors: Klim S,Kelly AM,Krieser D

    更新日期:2020-01-21 00:00:00

  • Planning emergency medical services for children in Bolivia: part 1-the use of rapid assessment procedures.

    abstract:OBJECTIVES:To describe an expedited process for collecting social and cultural data before program planning to develop emergency medical services for children in La Paz, Bolivia. The overall goal was to understand the relevant issues from the point of view of those most affected. METHODS:An interdisciplinary collabora...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/01.pec.0000139737.08474.b0

    authors: Chin NP,Goepp JG,Malia T,Poordabbagh A

    更新日期:2004-09-01 00:00:00

  • A Pulse Check on Leadership and Teamwork: An Evaluation of the First 5 Minutes of Emergency Department Resuscitation During Pediatric Cardiopulmonary Arrests.

    abstract:OBJECTIVES:Effective leadership and teamwork are imperative during pediatric cardiopulmonary resuscitations (CPR). The initial phase of pediatric CPR, termed the "first 5 minutes," has significant care delivery gaps in both leadership and team performance. The aim of the study was to describe the performance data of em...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001923

    authors: Grimsley EA,Cochrane NH,Keane RR,Sumner BD,Mullan PC,OʼConnell KJ

    更新日期:2019-12-13 00:00:00

  • Ten-year retrospective study of delayed diagnosis of injury in pediatric trauma patients at a level II trauma center.

    abstract:BACKGROUND:Published rates of delayed diagnosis of injury (DDI) in pediatric trauma vary from 1.0% to 18%. The purpose of this study was to determine the long-term trend of DDI over 10 years, to identify risk factors associated with DDI, and to elucidate patterns of DDI. METHODS:All patients aged 14 and younger who we...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e3181b0a07d

    authors: Williams BG,Hlaing T,Aaland MO

    更新日期:2009-08-01 00:00:00