Acute onset, altered mental status


• Scene – vitals, EKG, IV 18g, 1000ml fluids WO, CBG, neuro check
• En route – fluids continued, oxygen 2l NC, call to ED, call to Poison Control
• Hospital – transferred from ED to ICU for observation


• Response to treatment – vitals stabilized with fluid, no change in mentation
• Disposition – observation for Seroquil overdose


• Elliot Williams, Paramedic Woodburn Ambulance
• Vladamir Novikov, Paramedic Woodburn Ambulance


• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center

• Intentional overdose
• Seroquel overdose
• Quetiapine overdose
• Overdose

Differential Diagnosis

• Overdose (Intentional vs. non-intentional)
• Suicidal ideation
• Depression
• Intracranial bleed
• Closed head trauma/concussion

Patient Workup

• Patient states that he swallowed 5 x 150mg Seroquel and chewed up one 150mg Seroquel; denies any other medications
• States he did this to get “high”, not to try and hurt himself; states that he has cut and burned himself in the past
• Patient says he feels like he is walking on clouds, feels funny; denies shortness of breath, nausea, pain
• Mom noticed son acting funny, so she insisted he tell her what he had done and then called 911

Physical Exam

• GCS – 4/4/6
• EKG – STach
• CBG – 98
• Skin is pale, diaphoretic, pupils small
• Patient has scars on his forearms form self-mutilation in the past
• Patient appears somewhat out of it, very lethargic
• Very tachycardic initially, fluids helped to stabilize vitals

Editor’s Notes

Poison Control indicated that risk from Seroquel OD is tachycardia followed by hypotension. Can cause signifiacnt CNS depression. – Elliott Williams, Paramedic on scene, Woodburn Ambulance Service. There are sometimes unreported co-ingestants: alcohol, marijuana, narcotics, other prescription medications, or even acetaminophin. Frequently, toxicology screening is worth doing, along with a careful accounting of all medications in the home. ~ Dr. Keith Cross, Associate Professor of Pediatrics/Emergency Medicine, University of Louisville School of Medicine

Suggested References

Death associated with Quetiapine Overdose
Seroquel overdose


• Gender: Male
• Age: 15 years
• Height: Not Available
• Weight: Not Available


• Temperature: Not Available
• Blood Pressure: 107/80
• Heart Rate: 134
• Respiratory Rate: 14
• Pulse Oximetry: 98% RA
Signs and Symptoms
Altered mental status


• Bipolar, depression, ADHD
• Mom states patient has been using “drugs and alcohol lately”
• Allergies: NKDA
• Dispatch info: Overdose on seroquil


• Lives at homeMedications

• Seroquel
• Concerta
• Fluoxetine

Related videos