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array:22 [ "pii" => "S1134593423000210" "issn" => "11345934" "doi" => "10.1016/j.psiq.2023.100412" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "100412" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Psiquiatr Biol . 2023;30:" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S1134593423000222" "issn" => "11345934" "doi" => "10.1016/j.psiq.2023.100413" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "100413" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Psiquiatr Biol . 2023;30:" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review Article</span>" "titulo" => "Schizophrenia is associated with severe consequences" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Asociación de la esquizofrenia con consecuencias graves" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Kalyani Rajalingham" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Kalyani" "apellidos" => "Rajalingham" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1134593423000222?idApp=UINPBA00004N" "url" => "/11345934/0000003000000002/v1_202310012033/S1134593423000222/v1_202310012033/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review Article</span>" "titulo" => "Respiratory depression caused by low dose of olanzapine: A case report" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Masatoshi Inoue" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Masatoshi" "apellidos" => "Inoue" "email" => array:2 [ 0 => "inoue.masatoshi333@gmail.com" 1 => "inoue.masatoshi.n5@s.mail.nagoya-u.ac.jp" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Tsushima City Hospital, postcode:496-8537, 3-73 Tachibana-cho, Tsushima-city, Aichi, Japan" "identificador" => "af0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Depresión respiratoria causada por dosis baja de Olanzapina: informe de un caso" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Olanzapine, which is known as multi-acting receptor targeted antipsychotics (MARTA), is widely used throughout the world to treat patients with schizophrenia and bipolar disorder. Olanzapine has high affinity for serotonin, dopamine, alpha1-adrenergic, histamine H1, and muscarinic receptors and exhibits antidopaminergic, antiserotonergic, and antimuscarinic effects.<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> The main symptoms of olanzapine intoxication are decreased consciousness, hypotension, tachycardia, and excessive salivation, and usually symptomatic and supportive treatment is given.<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a> However, to our knowledge, respiratory depression has not been reported with doses as low as 5 mg. This study reports the case of an elderly woman with severe hypercarbia, hypoxia, and impaired consciousness possibly due to low doses of oral olanzapine. We expect that this case report will add to the existing body of literature on the appropriate use of olanzapine.</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">Clinical case</span><p id="p0010" class="elsevierStylePara elsevierViewall">A 78-year-old woman presented to the emergency department with impaired consciousness and hypoxia. She had a history of schizophrenia which had been treated with olanzapine 5 mg/day and valproic acid 200 mg/day for approximately 2 years in a psychiatrist's office. She had no medical or surgical history. She had no history of addiction, and her medications were properly administered by family members. Her Glasgow Coma Scale (GCS) score was E3V4M4, body temperature was 36.6 °C, blood pressure was 94/66 mmHg, respiratory rate was 14 breaths per minute, heart rate was 69 beats per minute, and oxygen saturation was 78% (room air). The surface electrocardiogram revealed a right bundle branch block. Transthoracic echocardiography showed normal cardiac function with an estimated ejection fraction of 60%. Chest X-ray revealed cardiomegaly with a cardio-thoracic ratio of 57.6% and pulmonary congestion. Head computed tomography was unremarkable. Arterial blood gas evaluation revealed severe hypoxemia, chronic respiratory acidosis, and metabolic alkalosis (pH 7.41; pO2 65.3 mmHg; PaCO2 82.7 mmHg; HCO3 46.8 mmol/L). Multiple nasal swab PCR tests for COVID-19 were negative. We diagnosed her for congestive heart failure and put on non-invasive positive-pressure ventilation (NPPV) with spontaneous/timed mode (FiO2 1.0; inspiratory positive airway pressure 10 cmH<span class="elsevierStyleInf">2</span>O; expiratory positive airway pressure 5 cmH<span class="elsevierStyleInf">2</span>O) in the emergency room. We suggested endotracheal intubation, but she and her family refused. We admitted her to the high care unit, treating her with intravenous bolus furosemide 40 mg/day, normal saline, and potassium chloride. All oral medications were discontinued. Serum renin was 0.2 (ng/mL/h, normal; 0.3–3.9) and aldosterone was 4.0 (pg/mL, normal; 40–82.1), ruling out primary aldosteronism. Because her breathing was shallow and slow (median tidal volume was 220 mL and respiratory rate was 14 breaths per minute), hypercarbia did not improve readily (<a class="elsevierStyleCrossRef" href="#t0005">Table 1</a>). Her level of consciousness gradually improved and her breathing became deeper and deeper. She was weaned from NPPV on day 19. She was discharged on day 30. Valproic acid was resumed after discharge from hospital, but the patient has progressed without recurrence.</p><elsevierMultimedia ident="t0005"></elsevierMultimedia></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Discussion</span><p id="p0015" class="elsevierStylePara elsevierViewall">Olanzapine has an average half-life of 33 h in healthy individuals, but longer in elderly patients, women, and non-smokers.<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a> Although there have been a few reports of olanzapine causing respiratory depression, most have been at very high doses, and this paper classifies 120–840 mg as moderate poisoning.<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> As far as we know, the lowest dose of olanzapine to cause coma was 20 mg/day, but this case did not cause respiratory depression.<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> The patient was an elderly non-smoking woman, who may have decreased clearance and increased blood levels of olanzapine.</p><p id="p0020" class="elsevierStylePara elsevierViewall">In a multicenter, randomized, double-blind, placebo-controlled study of 356 patients taking olanzapine 5 mg for 4 days in Japan, no cases of serious side effects, including respiratory depression, were observed.<a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a> In this case report, olanzapine caused edema that took 2 weeks to improve after discontinuation.<a class="elsevierStyleCrossRef" href="#bb0035"><span class="elsevierStyleSup">7</span></a> Our case took about the same amount of time. These findings suggest that olanzapine is accumulative and may take a long time to clear from the body when taken orally over a long period of time.</p><p id="p0025" class="elsevierStylePara elsevierViewall">There is no accepted antidote for the side effects of olanzapine, and hemodialysis does not remove olanzapine.<a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a> However, it has been reported that flumazenil<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> or an intravenous infusion of the lipid<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a> has improved the symptoms caused by olanzapine. These treatments are relatively harmless, it would have been worth trying in this case.</p><p id="p0030" class="elsevierStylePara elsevierViewall">An arterial blood gas test showed that HCO<span class="elsevierStyleInf">3</span> was markedly elevated and pH was almost normal on admission. Because hypochlorhydria and hypokalemia also produce chronic metabolic alkalosis, we started electrolyte correction from the time of admission.<a class="elsevierStyleCrossRef" href="#bb0050"><span class="elsevierStyleSup">10</span></a> Metabolic alkalosis persisted after electrolyte improvement, but acid–base balance tended to improve after resolution of respiratory depression. Based on the course of events, we concluded that the acid–base imbalance began with olanzapine-induced respiratory depression.</p><p id="p0035" class="elsevierStylePara elsevierViewall">She was elderly with dementia and may have been unaware of her symptoms. If somnolence is observed in a patient taking olanzapine, a blood gas should be obtained and appropriate respiratory care should be provided. Elderly patients, women, and non-smokers may have elevated olanzapine concentrations and may do better with lower than usual doses.</p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Author's Contribution</span><p id="p0040" class="elsevierStylePara elsevierViewall">Conception and design of study, Acquisition of data, Analysis and/or interpretation of data, Drafting the manuscript, Revising the manuscript critically for important intellectual content, and Approval of the version of the manuscript to be published: M. Inoue.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1979292" "titulo" => "Abstract" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "as0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "as0010" "titulo" => "Clinical case" ] 2 => array:2 [ "identificador" => "as0015" "titulo" => "Results and conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1702229" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1979291" "titulo" => "RESUMEN" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "as0020" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "as0025" "titulo" => "Caso clínico" ] 2 => array:2 [ "identificador" => "as0030" "titulo" => "Resultados y conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1702228" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "s0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "s0010" "titulo" => "Clinical case" ] 6 => array:2 [ "identificador" => "s0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "s0020" "titulo" => "Author's Contribution" ] 8 => array:2 [ "identificador" => "xack693702" "titulo" => "Acknowledgments" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-04-21" "fechaAceptado" => "2023-07-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1702229" "palabras" => array:3 [ 0 => "Respiratory depression" 1 => "Olanzapine" 2 => "Schizophrenia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1702228" "palabras" => array:3 [ 0 => "Depresión respiratoria" 1 => "Olanzapina" 2 => "Esquizofrenia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Objective</span><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Olanzapine is widely used throughout the world to treat patients with schizophrenia and bipolar disorder. Olanzapine has numerous side effects, but respiratory depression has not been reported with doses as low as 5 mg.</p></span> <span id="as0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Clinical case</span><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">An elderly woman presented with severe hypercarbia, hypoxia, and impaired consciousness possibly due to low doses of oral olanzapine. There is no accepted antidote for the side effects of olanzapine, so we followed the patient with respiratory support and electrolyte correction. Symptoms improved after 2 weeks and did not recur.</p></span> <span id="as0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Results and conclusions</span><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Elderly patients, women, and non-smokers may have elevated olanzapine concentrations and may do better with lower than usual doses. If somnolence is observed in a patient taking olanzapine, a blood gas should be obtained and appropriate respiratory care should be provided. We expect that this case report will add to the existing body of literature on the appropriate use of olanzapine.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "as0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "as0010" "titulo" => "Clinical case" ] 2 => array:2 [ "identificador" => "as0015" "titulo" => "Results and conclusions" ] ] ] "es" => array:3 [ "titulo" => "RESUMEN" "resumen" => "<span id="as0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">Objetivo</span><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Olanzapina se utiliza de manera amplia a nivel mundial para tratar a los pacientes con esquizofrenia y trastorno bipolar. Tiene numerosos efectos secundarios, pero no se había reportado depresión respiratoria con dosis bajas de 5 mg.</p></span> <span id="as0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Caso clínico</span><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">Una mujer mayor acudió con hipercarbia severa, hipoxia y deterioro de la consciencia, debido posiblemente a la administración de dosis bajas de olanzapina oral. No existe antídoto aceptado para los efectos secundarios de olanzapina, por lo que seguimos a la paciente con soporte respiratorio y corrección de electrolitos. Los síntomas mejoraron transcurridas dos semanas, no produciéndose recidiva.</p></span> <span id="as0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Resultados y conclusiones</span><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">Los pacientes mayores, mujeres, y no fumadores pueden tener concentraciones elevadas de olanzapina, siendo adecuado utilizar dosis más bajas de lo habitual. De observarse somnolencia en un paciente que toma olanzapina, deberán obtenerse gases sanguíneos, y aportarse cuidados respiratorios adecuados. Esperamos que este informe de caso ayude al cuerpo existente de la literatura con relación al uso adecuado de olanzapina.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "as0020" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "as0025" "titulo" => "Caso clínico" ] 2 => array:2 [ "identificador" => "as0030" "titulo" => "Resultados y conclusiones" ] ] ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "t0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference range \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">On admission \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hospital days 4 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hospital days 11 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hospital days 18 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.35–7.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.403 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.353 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.379 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.395 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pCO2 (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32–45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HCO3 (mmol/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.6–26.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sodium (mmol/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">138–146 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">145.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">149.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">140.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">138.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Potassium (mmol/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.6–4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chloride (mmol/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99–109 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3294421.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Laboratory investigations for the patient. Blood gas data is venous.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radioreceptor binding profile of the atypical antipsychotic olanzapine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "F.P. Bymaster" 1 => "D.O. Calligaro" 2 => "J.F. Falcone" 3 => "R.D. Marsh" 4 => "N.A. Moore" 5 => "N.C. Tye" 6 => "P. Seeman" 7 => "D.T. Wong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0893-133X(94)00129-N" "Revista" => array:7 [ "tituloSerie" => "Neuropsychopharmacology." "fecha" => "1996 Feb" "volumen" => "14" "numero" => "2" "paginaInicial" => "87" "paginaFinal" => "96" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8822531" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bb0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Olanzapine poisoning in patients treated at the National Poison Control Centre in Belgrade, Serbia in 2017 and 2018: a brief review of serum concentrations and clinical symptoms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "S. Đorđević" 1 => "N.P. Vukčević" 2 => "M. Antunović" 3 => "V. Kilibarda" 4 => "G.V. Ercegović" 5 => "J.J. Stošić" 6 => "S. Vučinić" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2478/aiht-2022-73-3635" "Revista" => array:7 [ "tituloSerie" => "Arh Hig Rada Toksikol." "fecha" => "2022 Jul 7" "volumen" => "73" "numero" => "2" "paginaInicial" => "126" "paginaFinal" => "130" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35792773" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bb0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Olanzapine. Pharmacokinetic and pharmacodynamic profile" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.T. Callaghan" 1 => "R.F. Bergstrom" 2 => "L.R. Ptak" 3 => "C.M. Beasley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2165/00003088-199,937,030-00001" "Revista" => array:7 [ "tituloSerie" => "Clin Pharmacokinet." "fecha" => "1999 Sep" "volumen" => "37" "numero" => "3" "paginaInicial" => "177" "paginaFinal" => "193" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10511917" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bb0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The clinical picture of olanzapine poisoning with special reference to fluctuating mental status" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Palenzona" 1 => "P.J. Meier" 2 => "H. Kupferschmidt" 3 => "C. Rauber-Luethy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1081/clt-120,028,741" "Revista" => array:7 [ "tituloSerie" => "J Toxicol Clin Toxicol." "fecha" => "2004" "volumen" => "42" "numero" => "1" "paginaInicial" => "27" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15083933" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bb0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coma, severe hypotension, and pinpoint pupils after olanzapine intoxication in the intensive care unit with symptom reversal after administration of flumazenil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Pålsson" 1 => "J. Guldberg" 2 => "J.M. Gustafsson" 3 => "H. Aiff" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.12659/AJCR.938387" "Revista" => array:5 [ "tituloSerie" => "Am J Case Rep." "fecha" => "2022 Dec 1" "volumen" => "23" "paginaInicial" => "e938387" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36451528" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bb0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Olanzapine 5 mg plus standard antiemetic therapy for the prevention of chemotherapy-induced nausea and vomiting (J-FORCE): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:18 [ 0 => "H. Hashimoto" 1 => "M. Abe" 2 => "O. Tokuyama" 3 => "H. Mizutani" 4 => "Y. Uchitomi" 5 => "T. Yamaguchi" 6 => "Y. Hoshina" 7 => "Y. Sakata" 8 => "T.Y. Takahashi" 9 => "K. Nakashima" 10 => "M. Nakao" 11 => "D. Takei" 12 => "S. Zenda" 13 => "K. Mizukami" 14 => "S. Iwasa" 15 => "M. Sakurai" 16 => "N. Yamamoto" 17 => "Y. Ohe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1470-2045(19)30678-3" "Revista" => array:7 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2020 Feb" "volumen" => "21" "numero" => "2" "paginaInicial" => "242" "paginaFinal" => "249" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31838011" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bb0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Olanzapine associated acute peripheral edema and pericardial effusion: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Arslan" 1 => "Ü. Bulut" 2 => "D.D. Naki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.29399/npa.22860" "Revista" => array:7 [ "tituloSerie" => "Noro Psikiyatr Ars." "fecha" => "2019 Mar" "volumen" => "56" "numero" => "1" "paginaInicial" => "79" "paginaFinal" => "81" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30911243" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bb0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antipsychotics and hemodialysis: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Sutar" 1 => "M.K. Atlani" 2 => "P. Chaudhary" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajp.2020.102484" "Revista" => array:6 [ "tituloSerie" => "Asian J Psychiatr." "fecha" => "2021 Jan" "volumen" => "55" "paginaInicial" => "102484" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33341539" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002939418304768" "estado" => "S300" "issn" => "00029394" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bb0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravenous lipid infusion restores consciousness associated with olanzapine overdose" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B.S. Yurtlu" 1 => "V. Hanci" 2 => "A. Gür" 3 => "I.O. Turan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e318213f377" "Revista" => array:7 [ "tituloSerie" => "Anesth Analg." "fecha" => "2012 Apr" "volumen" => "114" "numero" => "4" "paginaInicial" => "914" "paginaFinal" => "915" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22434897" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bb0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathophysiology, evaluation, and management of metabolic alkalosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Tinawi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7759/cureus.12841" "Revista" => array:6 [ "tituloSerie" => "Cureus." "fecha" => "2021 Jan 21" "volumen" => "13" "numero" => "1" "paginaInicial" => "e12841" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33628696" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack693702" "titulo" => "Acknowledgments" "texto" => "<p id="p0050" class="elsevierStylePara elsevierViewall">None.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/11345934/0000003000000002/v1_202310012033/S1134593423000210/v1_202310012033/en/main.assets" "Apartado" => array:4 [ "identificador" => "8317" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Revisión" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/11345934/0000003000000002/v1_202310012033/S1134593423000210/v1_202310012033/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1134593423000210?idApp=UINPBA00004N" ]
