Rare case of Acute kidney injury in patient with Tianeptine Toxicity: A Report

USA: An article reports a case of acute kidney injury (AKI) in a patient with Tianeptine Toxicity. The case was presented at National Kidney Foundation 2023 Spring Clinical Meeting. 

AKI remains a leading finding among patients presenting to ER (emergency rooms) regardless of their chief complaints. Tianeptine is a selective serotonin reuptake enhancer with mu-opioid receptor agonist properties at high doses. In European countries, it is prescribed as an antidepressant, but it is not currently approved in the US. Currently, tianeptine is being marketed as a cognitive enhancer in the US. There are limited published case reports of tianeptine intoxication.

The case in question is of a 28-year-old white male with a PMH of Cyclic Vomiting Syndrome who presented to the emergency room for vomiting, nausea, and abdominal pain for 3 days and reduced urinary output for one day. The patient reportedly took recreational Tianeptine 2000 mg three times within the week before admission and marijuana. He denied ingesting any other substances.

The patient was restless, agitated, tachypneic, diaphoretic, and actively dry heaving on examination. He had diffuse abdominal tenderness with no guarding. Workup in the ER was notable for a negative non-contrast CT abdomen and pelvis. Labs showed creatinine 3.34 (baseline 0.9), mixed anion gap metabolic acidosis and resp alkalosis, WBC 18.6, Hgb 18.8, Ca 12.7, CK 1266, and negative ethanol, methanol, and ethylene glycol. Urinalysis was only positive for numerous calcium oxalate crystals.