Life-Threatening Cardiogenic Shock Related to Venlafaxine Poisoning-A Case Report with Metabolomic Approach

Overview

Journal Metabolites

Publisher MDPI

Date 2023 Mar 29

PMID 36984793

Authors

Romain Magny

Bruno Megarbane

Pauline Guillaud

Lucie Chevillard

Nicolas Auzeil

Pauline Thiebot

Sebastian Voicu

Isabelle Malissin

Nicolas Deye

Laurence Labat

Pascal Houze

Affiliations

Soon will be listed here.

Abstract

Metabolomics in clinical toxicology aim at reliably identifying and semi-quantifying a broad array of endogenous and exogenous metabolites using dedicated analytical methods. Here, we developed a three-step-based workflow to investigate the metabolic impact of the antidepressant drug venlafaxine in a poisoned patient who developed life-threatening cardiac failure managed with extracorporeal membrane oxygenation. Both targeted quantitative and untargeted semi-quantitative metabolomic analyses using liquid chromatography hyphenated to high-resolution tandem mass spectrometry were performed to determine the plasma kinetics of venlafaxine, -desmethyl-venlafaxine, and -desmethyl-venlafaxine and to identify sixteen different venlafaxine-derived metabolites including one unknown (, venlafaxine conjugated to a hexosyl-radical), respectively. Correlations between the quantitative metabolomic data and annotated endogenous metabolites suggested impaired amino acid and lipid metabolism, Krebs cycle, and kynurenine pathway. This preliminary study represents a first step towards a more extensive application of toxicometabolomics in clinical toxicology and a useful workflow to identify the biomarkers of toxicity.

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