Emergent Antidepressant Discontinuation Syndrome Misdiagnosed as Delirium in the ICU
Table 1
Richmond Agitation Sedation Scale (RASS), Behavioral Pain Scale (BPS) Confusion Assessment Method for the ICU (CAM-ICU), and selected medications for postoperative days 10 – 27.
POD 10
POD 11
POD 12
POD 13
POD 14
POD 15
POD 16
POD 17
POD 18
POD 19
POD 20
POD 21
POD 22
POD 23
POD 24
POD 25
POD 26
POD 27
RASS, max./min.
0/0
1/1
-1/-2
-1/-2
1/-2
1/-2
3/-3
-1/-1
1/-3
2/-3
3/-4
2/-2
1/1
-1/-1
-1/-1
0/0
0/0
0/-1
BPS, max.
N/A
N/A
0
1
6
8
8
0
4
9
8
2
2
1
1
N/A
N/A
CAM-ICU
N/A
N/A
No
Yes
Yes
Yes
N/A
Yes
Yes
N/A
Yes
Yes
Yes
N/A
N/A
Yes
No
No
Fentanyl gtt max/min (IVP)
(700)
---
---
250/200
250/150 (25)
200/200
250/150
250/200
250/200
250/250
250/200
200/50
200/50
90/50
70/0
---
---
---
Midazolam max/min (IVP)
---
---
---
4/3
4/2
6/1
8/0
8/4
8/4 (5)
8/3
8/1
4/0
5/0
---
---
---
---
---
Dexme gtt max/min
---
---
1/0
1.2/0
---
---
1.2/0
0.80.2
1/0.2
1.2/0.6
1.2/0.4
0.6/0
0.6/0.6
---
---
---
---
---
Propofol max/min
---
---
15/0
---
---
---
---
---
---
---
15/0
50/15
50/30
40/25
40/20
30/0
---
---
Duloxetine
120
120
120
0
0
0
0
0
0
0
120 (crushed)
0
120 (crushed)
0
0
0
0
0
Venlafaxine
0
0
0
0
0
0
0
0
0
0
75
75
150
150
225
225
150
300
Olanzapine
0
0
0
0
0
0
0
0
7.5
15
7.5
15
15
15
15
15
7.5
0
Abbreviations RASS: Richmond Agitation Sedation Scale BPS: Behavioral Pain Scale CAM-ICU: Confusion Assessment Method for the ICU dexme: dexmedetomidine max.: the maximum IV dose (mcg for fentanyl and mg for midazolam)/infusion rate (mcg /hr for fentanyl, mcg/kg/hr for dexmedetomidine, and mcg/kg/min for propofol) min.: the minimum IV dose/infusion rate (dosing units and concentrations the same as for maximum). IVP: IV push medication gtt: IV infusion. Duloxetine, venlafaxine, and olanzapine daily dose is in mg.
