(1168) The Serotonin Saga: When Venlafaxine Unleashed Chaos and ARDS

Introduction: A Case of venlafaxine overdose resulting serotonin syndrome and an uncommon adverse effect ARDS

Description: A 52-year-old female patient presented to the emergency department with intentional venlafaxine overdose of approximately 30 tablets. The patient exhibited seizure-like activity and subsequent airway compromise, necessitating prompt intubation and admission to the ICU. The patient received supportive management, including mechanical ventilation, correction of metabolic and respiratory acidosis, and serial EKG monitoring showing QTc prolongation and clonic posturing. 48Hr after admission, the patient’s oxygen requirement progressively worsened (PF ratio < 100). CXR showed development of bilateral ground-glass opacities, consistent with ARDS. The patient was positioned in a prone position for 16 hours and received low tidal volume ventilation, leading to improvement in oxygenation and eventually decreased oxygen requirements. After six days, the patient was successfully extubated and transferred for psychiatric evaluation and management.

Discussion: Serotonin syndrome, a recognized deleterious outcome of selective serotonin reuptake inhibitors (SSRIs), is more prominent with serotonin-norepinephrine reuptake inhibitors (SNRIs). The present case report involves a patient who displayed typical signs of venlafaxine toxicity, encompassing seizures, cognitive changes, and clonus. Further, previous literature has documented the occurrence of citalopram-induced serotonin syndrome that culminates in acute respiratory distress syndrome (ARDS). However, the evidence base for venlafaxine-induced ARDS remains scarce. Clinicians should have a high level of suspicion for such interaction in their practice for timely recognition and treatment.