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. 

The patient received 3L of IV NS. Repeat labs in 4 hours showed a resolution of acidosis and a creatinine of 2.67. Lactic acid was only checked after fluid resuscitation and was 1.9. To manage uncontrolled agitation with IV preceded, the patient was transferred to the ICU.  IV fluids were continued.

On Day 3, the patient appeared less agitated. Repeat labs showed Cr 1.74, CK 890, Ca 9.1, and UA negative for Ca oxalate. Tianeptine abuse and dependence have become increasingly prominent worldwide, with a recent presence in the US. AKI and acidosis have been reported in very few cases of Tianeptine exposure.

"The mechanism of AKI is uncertain but may be due to large insensible losses and rhabdomyolysis,"Mai Abouelsaad, University of Texas Medical Branch, and colleagues wrote. "Anticipating the clinical manifestations associated with Tianeptine toxicity, such as hyperoxaluria, AKI, rhabdomyolysis, and anion gap metabolic acidosis, can guide the timely management of those patients and help prevent major adverse outcomes."

Reference:

A CASE OF AKI IN A PATIENT WITH TIANEPTINE TOXICITY. Presented at National Kidney Foundation 2023 Spring Clinical Meeting.