Supplementary Material for: Hemodialysis treatment high-dose quetiapine fumarate poisoning: A case report

Introduction: Quetiapine is a new atypical antipsychotic with minor side effects. There have been few reports of rhabdomyolysis and acute kidney injury associated with quetiapine overdose. Case Presentation: This article presents a rare case of high-dose quetiapine poisoning that improved after treatment. The patient experienced rhabdomyolysis, acute kidney injury, long QT syndrome, and peripheral nerve injury, all of which are typical complications of quetiapine poisoning. Moreover, a kidney biopsy verified the patient’s acute tubulointerstitial injury, and immunohistochemical staining demonstrated that myoglobin cast nephropathy was the cause of the injury. This patient’s kidney function and associated complications recovered after receiving hemodialysis, rehabilitation, heart rate regulation, and further symptomatic interventions. Consequently, hemodialysis was discontinued. Conclusion: Our case showed that myoglobin cast nephropathy was the cause of the acute kidney injury associated with quetiapine poisoning. The kidney biopsy is essential for accurate diagnosis and treatment.

引言：喹硫平（Quetiapine）是一种新型非典型抗精神病药物，副作用轻微。目前关于喹硫平过量导致横纹肌溶解症（rhabdomyolysis）及急性肾损伤（acute kidney injury）的报道较少。
病例报告：本文呈现1例大剂量喹硫平中毒经治疗后好转的罕见病例。患者出现横纹肌溶解症、急性肾损伤、长QT综合征（long QT syndrome）及周围神经损伤，均为喹硫平中毒的典型并发症。此外，肾活检证实患者存在急性肾小管间质损伤（acute tubulointerstitial injury），免疫组化染色显示肌红蛋白管型肾病（myoglobin cast nephropathy）是其损伤原因。患者经血液透析、康复治疗、心率调控及进一步对症干预后，肾功能及相关并发症均得到恢复，随后停用血液透析。
结论：本病例提示，肌红蛋白管型肾病是喹硫平中毒相关急性肾损伤的病因。肾活检对于准确诊断与治疗至关重要。