Past Issues

Severe Acidosis Followed by Withdrawal Delirium and Dystonia-like Movement after Clozapine Overdose

Tzu I Lee, I Hui Lee, An-Bang Wu, Yen Kuang Yang

Background: Due to receptor-binding complexity of clozapine, the symptoms
of its overdose and withdrawal are complicated and vary greatly in different
patients. Case Report: The case report describes a schizophrenic patient who took
5,000 mg clozapine in a suicidal attempt. He suffered from metabolic acidosis,
generalized tonic and clonic seizures with respiratory failure. The patient regained
clear consciousness after clozapine was withheld. Delirium, dystonia-like movement
and rebound psychosis emerged on the 4th day. Clozapine withdrawal was
the most likely the cause, and above-symptoms were improved gradually after
clozapine was reloaded. Conclusion: We suggest that clozapine overdose may
lead to lactic acidosis even without the complications of hypotension and respiratory
failure. Several mechanisms are attributed to the various presentations of clozapine
withdrawal. The manifestations in our patient underscored the risk of severe
acidosis after clozapine overdose and the importance of prevention of
clozapine withdrawal.
Key Word clozapine, lactic acidosis, intoxication, withdrawal
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