Introduction: Aripiprazole is an atypical antipsychotic with unique receptor-binding properties that has a favorable safety profile in therapeutic doses compared to other antipsychotics. Massive aripiprazole overdose in children, however, presents with profound lethargy and may have neurologic, hemodynamic, and cardiac effects, often requiring admission to a high level of care.

Case Report: We describe a case of a 21-month-old male with a reported 52-milligram aripiprazole ingestion. Initial vital signs were remarkable for tachycardia and hypertension, which rapidly resolved. The patient did not develop hypotension throughout hospitalization. He experienced 60 hours of lethargy. Irritability associated with upper extremity spasms and tremors occurred from 36-72 hours post ingestion, which resolved without intervention. The initial electrocardiogram demonstrated ST-segment depressions in the anteroseptal leads; further cardiac workup was normal. Concurrent medical workup was unrevealing. Aripiprazole and dehydro-aripiprazole serum concentrations sent 46 hours after reported exposure were 266.5 nanograms per milliliter (ng/mL) and 138.6 ng/mL, respectively. He returned to neurologic baseline and was discharged 72 hours after ingestion.

Conclusion: Antipsychotics, including aripiprazole, should be considered as a potential toxicological cause of persistent central nervous system depression; ingestion of a single dose has the potential to cause significant toxicity.

Introduction: Coronavirus 2019 (COVID-19) illness continues to affect national and global hospital systems, with a particularly high burden to intensive care unit (ICU) beds and resources. It is critical to identify patients who initially do not require ICU resources, but subsequently rapidly deteriorate. We investigated patient populations during COVID-19 at times of full or near full (surge) and non-full (non-surge) hospital capacity to determine the effect on those who may need a higher level of care or deteriorate quickly defined as requiring a transfer to ICU within 24 hours of admission to a non-ICU level of care and provide further knowledge on this high-risk group of patients. 

Methods: This was a retrospective cohort study of a single health system comprising four emergency departments and three tertiary hospitals in New York, New York across two different time periods (during surge and non-surge inpatient volume times during the COVID-19 pandemic).  The electronic health record was queried for all patients admitted to a non-ICU setting with unexpected ICU transfer (UIT) within 24 hours of admission. A comparison between adult patients with confirmed coronavirus 2019 and without was made during surge and non-surge time periods.

Results: During the surge time period, there was a total of 86 UITs in a one month period. Of those 60 were COVID positive patients who had a mortality rate of 63.3% and 26 were COVID negative with a 30.8 % mortality rate. During the non-surge time period, there was a total of 112 UITs, of those 24 were COVID positive with a 37.5% mortality rate and 90 were COVID negative with a 11.1% mortality rate. 

Conclusion: During surge, the mortality rate for both COVID positive and COVID negative patients experiencing an unexpected ICU transfer is significantly higher.