Unveiling Cardiac Complications: A Case of Amisulpride Overdose Leading to Bradycardia, QT-Prolongation, and Torsade de Pointes Tachycardia

Suicide attempts involving self-poisoning with benzodiazepines, antipsychotic drugs, or antidepressants are prevalent in emergency departments and intensive care units. Managing these patients is often complex and relies predominantly on local expertise and experience. Treatment options for overdose of orally ingested substances include gastroscopy with gastric lavage and activated charcoal therapy. However, there are limited data regarding the effectiveness of delayed treatment initiation and associated clinical benefits. Overdose with antipsychotic drugs, such as amisulpride, can lead to severe cardiac side effects, including bradycardia, QT prolongation, and subsequent torsade de point tachycardia. This report describes a 65-year-old woman who ingested of 40g amisulpride with suicidal intent. The patient presented with bradycardia necessitating temporary pacing and QT prolongation, which resulted in torsade de point tachycardia. Due to the severe cardiac, hemodynamic, and central nervous system complications of the intoxication, the authors opted for gastroscopy with gastric lavage and activated charcoal therapy, despite the intake taking place >7 hours ago. Amisulpride plasma concentrations were measured using liquid chromatography coupled with high-resolution mass spectrometry at various time points, including before and after gastroscopy. In addition, a qualitative measurement of amisulpride in stomach contents was performed. Drawing insights from this case, the authors explored optimal approaches for managing cardiac side effects and assessed the value of gastric lavage and activated charcoal therapy in contemporary intensive care medicine. Why should physicians and toxicologists be aware of this issue? (1) To detect and treat possible cardiac side effects, such as torsade de point tachycardia, and (2) To understand the role of gastric lavage and activated charcoal therapy in patients with poisoning.