%0 Journal Article
%T Mort subite chez un patient trait¨¦ pour schizophr¨¦nie r¨¦fractaire par clozapine (Leponex ) Sudden death with clozapine and refractory schizophrenia : a case study
%A Aknouche Fr¨¦d¨¦ric
%A Quatrehomme G¨¦rald
%A Guibert Emilie
%A Eyraud Matthieu
%J Annales de Toxicologie Analytique
%D 2012
%I 
%R 10.1051/ata/2012017
%X Introduction : Les auteurs se proposent de mettre en ¨¦vidence la cause du d¨¦c¨¨s d¡¯une jeune fille hospitalis¨¦e pour un ¨¦pisode schizophr¨¦nique et d¨¦c¨¦d¨¦e treize jours plus tard. Description du cas : Suite ¨¤ l¡¯absence d¡¯¨¦l¨¦ment retrouv¨¦ lors de l¡¯autopsie et compte tenu de l¡¯aspect subit et inattendu du d¨¦c¨¨s, diff¨¦rentes expertises toxicologiques et anatomo-pathologiques se sont succ¨¦d¨¦. Le traitement au moment du d¨¦c¨¨s consistait en : Leponex  (clozapine) 25 ¨¤ 50 mg per os, Tercian  (cyam¨¦mazine) 300 mg per os, Th¨¦ral¨¨ne  (alim¨¦mazine) 30 gouttes per os, et Imovane  (zopiclone) 7,5 mg per os si besoin et Loxapac  (loxapine) en cas d¡¯agitation importante. Lors de l¡¯autopsie, un  d¨¨me pulmonaire d¡¯origine toxique a ¨¦t¨¦ mis en ¨¦vidence. R¨¦sultats : Les analyses toxicologiques ont r¨¦v¨¦l¨¦ que les concentrations sanguines suite ¨¤ l¡¯administration des doses prescrites ¨¦taient en dehors des fourchettes th¨¦rapeutiques habituelles retrouv¨¦es. Dans le sang f¨¦moral, la concentration de loxapine trouv¨¦e est de 65 ng/mL, celle de clozapine ¨¤ 660 ng/mL, d¡¯alim¨¦mazine ¨¤ 250 ng/mL et de cyam¨¦mazine ¨¤ 540 ng/mL. Conclusion : La prescription m¨¦dicale, en termes de doses prescrites, d¡¯association des m¨¦dicaments, et la surveillance a ¨¦t¨¦ conforme aux r¨¨gles de l¡¯art. L¡¯hypoth¨¨se de la prise surajout¨¦e de m¨¦dicaments est au premier plan. La cause du d¨¦c¨¨s retenue est la mort subite par effet d¨¦l¨¦t¨¨re cardio-vasculaire. Introduction: We present the case of the death of a young girl hospitalized for a schizophrenic episode, who died thirteen days later. Case report: Due to the absence of any specific findings at the autopsy and given the sudden and unexpected aspect of her death, different toxicological and pathological expertise was requested. The treatment at the time of death included: Leponex  (clozapine) from 25 to 50 mg orally, Tercian  (cyamemazine) 300 mg orally, Th¨¦ral¨¨ne  (alimemazine) 30 drops orally, Imovane  (zopiclone) per os 7.5 mg and Loxapac  (loxapine) if necessary. During the autopsy, a toxicity-induced pulmonary oedema was observed. Results: Toxicology tests showed that blood concentrations following administration of prescribed doses were outside the usual therapeutic ranges found. In the femoral blood, the concentration of loxapine was 65 ng/mL, clozapine was at 660 ng/mL, alimemazine was at 250 ng/mL and cyamemazine was at 540 ng/mL. Conclusion: The prescription, in terms of prescribed doses, association of drugs and monitoring, was consistent with the state of the art. The hypothesis of taking added drugs is the most likely. The cause of death was rul
%K Mort subite
%K clozapine
%K schizophr¨¦nie r¨¦fractaire
%K Sudden death
%K clozapine
%K refractory schizophrenia
%U http://dx.doi.org/10.1051/ata/2012017