SHM Converge Scientific Abstract ePoster Gallery-Detoxification to a Toxidrome

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This case report describes a 28-year-old woman who arrived at the emergency department with altered mental status, confusion, and bizarre behavior after attempting a grapefruit “detox.” Her workup showed leukocytosis, ketones in the urine, a high anion gap metabolic acidosis with a mixed acid-base disturbance, and a positive THC screen. Collateral history raised concern for possible ingestion of quetiapine and zolpidem, and an empty gallon of grapefruit juice was found at her bedside.<br /><br />She was treated with intravenous fluids and admitted for monitoring. Her mental status and laboratory abnormalities improved rapidly. She later denied suicidal intent or deliberate overdose, but reported drinking about one gallon of grapefruit detox juice the day before presentation. The authors concluded that her illness was likely multifactorial but mainly due to quetiapine toxicity made worse by grapefruit juice.<br /><br />The discussion emphasizes that grapefruit juice is a potent inhibitor of cytochrome P450 enzymes, especially CYP3A4. Because quetiapine is metabolized by CYP3A4, grapefruit consumption can raise quetiapine levels and lead to unintentional overdose. Potential consequences include CNS depression, cardiac arrhythmias, and rhabdomyolysis.<br /><br />The main takeaway is that hospitalists and other clinicians should recognize dietary drug interactions, especially with grapefruit, and educate patients about the risks of combining “detox” products or foods with prescription medications.

Asset Subtitle

Amritpal S. Pannu

Meta Tag

Author List Amritpal S. Pannu, Ramandeep Kaur, Sumera Andleeb

Category Clinical Vignettes

Concept Grapefruit Juice

Concept Quetiapine

Concept Quetiapine Toxicity

Concept Cytochrome P450 Inhibitor

Concept Drug Interaction

Distinguished Non-Finalist

Presenter Organization Wake Forest University of Health Sciences

Presenting Author Amritpal S. Pannu

Track Adult

Keywords

grapefruit juice

quetiapine toxicity

CYP3A4 inhibition

drug interaction

altered mental status

high anion gap metabolic acidosis

zolpidem

THC screen

detox juice

emergency department

Grapefruit Juice

Quetiapine

Quetiapine Toxicity

Cytochrome P450 Inhibitor

Drug Interaction