Refractory cardiogenic shock due to atomoxetine overdose rescued by venoarterial extracorporeal membrane oxygenation: A case report

• Published in: Acute medicine & surgery 2024-01, Vol.11 (1), p.e70001-n/a
• Main Authors: Komoriya, Kenta, Kitagawa, Kanta, Mihara, Yutaka, Hagiwara, Kei, Hatanaka, Yasuhito, Hikone, Mayu, Sugiyama, Kazuhiro
• Format: Article
• Language: English
• Subjects: atomoxetine; Attention deficit hyperactivity disorder; Blood; Cardiac arrhythmia; cardiac failure; Cardiac function; Cardiomyopathy; Case Report; Conflicts of interest; Consent; Drug dosages; Electrocardiography; Extracorporeal membrane oxygenation; Hyperactivity; Intensive care; intravenous lipid emulsion; Kinases; Nervous system; overdose; Pharmacists; Potassium; Toxicity; Vital signs
• ISSN: 2052-8817; 2052-8817
• DOI: 10.1002/ams2.70001

Background Atomoxetine, a selective norepinephrine reuptake inhibitor for attention‐deficit hyperactivity disorder, may lead to severe complications, notably cardiac issues, upon overdose. We present a unique case of venoarterial extracorporeal membrane oxygenation (VA‐ECMO) rescue for atomoxetine‐induced cardiogenic shock. Case Presentation We report a 30‐year‐old man who, after ingesting a significant overdose of atomoxetine, experienced seizures and severe cardiogenic shock, necessitating VA‐ECMO for resuscitation. While prior reports have noted cardiovascular complications like QTc prolongation and Takotsubo cardiomyopathy following atomoxetine overdose, this case is notable for its life‐threatening circulatory failure, which required ECMO intervention. Swift recognition coupled with VA‐ECMO initiation, endoscopic medication removal, intravenous lipid emulsion, and activated charcoal may have played a pivotal role in stabilizing the patient and facilitating recovery. Conclusion Healthcare practitioners should recognize the severe cardiac complications of atomoxetine overdose. Careful monitoring with ECG and echocardiography, along with providing intensive care, is crucial in managing critical cases. A 30‐year‐old male experienced refractory cardiogenic shock following an atomoxetine overdose, characterized by wide QRS complexes and QT prolongation. Rapid initiation of venoarterial ECMO was crucial for rescue. This case underscores the pivotal role of ECMO in the management of severe atomoxetine toxicity.