LAUSR

CASE REPORT In a suicide attempt a 50-year-old man with a 30-year history of schizoaffective psychosis took 90 amisulpride 400-mg tablets, amounting to a total dose of 36 g. Shortly after taking the tablets, the patient informed his partner, a resident of the same assisted living facility for people with mental health issues. An ambulance arrived 40 minutes after ingestion to find the man in a deeply comatose state (GlasgowComaScore 3)with respiratory insufficiency (peripheral oxygen saturation of 60%) and bradycardia (heart rate =30bpm).After insertion of a supraglottic airway device to keep the patient's airways open, he was brought to the emergency department. On the way, the patient sustained a generalized seizure, which ceased after intravenous administration of midazolam 2 mg. Upon arrival in the emergency department, the patient was still comatose. Both pupils were fixed and dilated and the left pupil was irregular in shape. Initial noninvasive blood pressure monitoring in the emergency department showed a value of 50/30 mm Hg. Endotracheal intubation and controlled ventilation were accomplished with no need for further medication. After primary cardiovascular stabilization with infusions of crystalloid solutions and norepinephrine, a cranial computed tomography scan showed no evidence of intracranial pathology. In consultation with the special poison control centers available in Germany, physostigmine 2 mg was administered