Severe clozapine toxicity-The pharmacokinetic profile of clozapine and it’s important role in hemodynamic：case report

Background: Hemodynamic instability in patients with clozapine intoxication can indirectly reflect the serum concentration of clozapine. Case presentation: We have described a case of a 32-year-old pregnant woman who developed life-threatening clozapine toxicity at 28 weeks of gestation. The levels of clozapine and norclozapine in the serum were high.We initiated hemoperfusion(HP) and other detoxification therapies to remove the drug. The patient had severely dilated peripheral blood vessels, which led to cardiac symptoms such as fatal hypotension and uncontrollable tachycardia, resulting in very high cardiac output and elevated Central venous oxygen saturation(ScvO 2 ). Pharmacological intervention significantly improved the hemodynamics. Conclusions: Based on our findings in the current case, we hypothesize that hemodynamic monitoring before and after blood detoxification can help assess the efficacy and guide treatment.