Coma with accidental single dose of an atypical neuroleptic in a patient with Lewy Body Dementia [2]

FreeText:The patient was diagnosed with DLB on the basis of a 6-year history of progressive memory, language, gait, and functional impairment, parkinsonian signs, marked visual hallucinations, and fluctuating confusion. He was withdrawn from risperidone 0.5 mg daily in 1999 because of the development of a sensitivity syndrome. He had not been able to walk and was unable to raise himself from a chair. His medical history included an allergy to sulfa drugs, type 2 diabetes, stroke, deafness, myocardial infarction, pulmonary embolism, and osteoarthritis. 2 years ago, he was admitted to a long term care hospital with agitation and functional decline. His medications on admission were L- thyroxin 0.1 mg, donepezil 10 mg, coumadin 35 mg orally once daily, and trazodone 75 mg at bedtime. A few months after admission, and, while agitated, he received Leponex 175 mg in error.

AuthorsConclusions:If patients with DLB require a neuroleptic (for example, for hallucinations that do not respond to a cholinesterase inhibitor) then this case, and others, suggest that extreme caution be used regardless of the class of neuroleptics. Dosing should be minimized, and careful monitoring should be instituted, preferably, perhaps, in the hospital. It should also be noted that previous response to atypical neuroleptics could be an unreliable indicator of future response.

Indications:1 patient with dementia with Lewy body characterized by agitation and functional decline. Coexisting diseases were type 2 diabetes mellitus and osteoarthritis.

Patients:One 86-year-old man (outpatient).

Results:Soon thereafter he became very confused and after 2 hours was obtunded. Examination revealed no spontaneous eye opening, no verbal response, and only a withdrawal motor response (Glasgow Coma Scale score: 6). He had pinpoint pupils, with sluggish reaction to light. When the neurological examination was repeated 4 days later, his coma showed only slight improvement. His pupils were now reactive; he raised his eyebrows in response to voice, and he grimaced in response to painful stimuli. His muscle tone was rigid in both arms, but he was able to move all limbs. Occasional myoclonus was noted. Laboratory evaluation revealed a serum creatine kinase of 327 IU/L. By Day 9, he responded to verbal stimuli. Full consciousness and mobility were regained only by Day 14.

TypeofStudy:A case of coma induced by an accidental single dose of Leponex in a patient with Dementia with Lewy body (DLB) is reported as a case report in a letter. Letters to the editor.

DosageDuration:A single dose of 175 mg orally given in error.

AdverseEffects:1 patient had coma and occasional myoclonus due to neuroleptic sensitivity.