Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers
Introduction. Calcium channel blockers and beta-blockers are among the most frequently ingested cardiovascular drugs in self-poisoning causing significant mortality. Intravenous lipid emulsion (ILE) is reported as a potentially novel antidote for treatment of acute poisoning caused by some...
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| Format: | Article |
| Language: | English |
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2016-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2016/0042-84501500018J.pdf |
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| author | Jović-Stošić Jasmina Putić Vesna Živanović Dragan Mladenov Milica Brajković Gordana Đorđević Snežana |
| author_facet | Jović-Stošić Jasmina Putić Vesna Živanović Dragan Mladenov Milica Brajković Gordana Đorđević Snežana |
| author_sort | Jović-Stošić Jasmina |
| collection | DOAJ |
| description | Introduction. Calcium channel blockers and beta-blockers are among the most
frequently ingested cardiovascular drugs in self-poisoning causing
significant mortality. Intravenous lipid emulsion (ILE) is reported as a
potentially novel antidote for treatment of acute poisoning caused by some of
these drugs. Case report. We presented two cases of poisoning with these
drugs. The case 1, a 24-year-old woman ingested amplodipine, metformin and
gliclazide for self-poisoning. She presented with tachycardia and
hypotension. Laboratory analyses revealed hyperglycaemia and metabolic
acidosis. Despite the treatment which included fluid resuscitation,
vasopressors, intravenous calcium, glucagon and ILE, circulatory shock
occurred. The patient died 10 hours after admission due to cardiac arrest
refractory to cardiopulmonary resuscitation. The case 2, a 41-year old man,
was found in a coma with empty packages of nifedipine, metoprolol and
diazepam tablets. On admission vital signs included Glasgow Coma Scale (GCS)
of 3, weak palpable pulses, undetectable blood pressure, and irregular
breathing with oxygen saturation of 60%. An electrocardiography showed AV
block (Mobitz II) with ventricular rate of 44/min with progression to third
degree of AV block. In attempt to increase heart rate and blood pressure the
following agents were administered: atropine boluses, normal saline with
dopamine, glucagon, calcium chloride and ILE. Temporary transvenous pacemaker
was placed, electrical capture was recorded, but without improvement in
haemodynamics. Three hours after admission cardiac arrest happened and
cardiopulmonary resuscitation was unsuccessful. Conclusion. Intravenous lipid
emulsion may be ineffective in acute poisonings with amlodipine, nifedipine
or metoprolol. |
| format | Article |
| id | doaj-art-bf2ae5e916b8481b9557d5fa4d0a7189 |
| institution | OA Journals |
| issn | 0042-8450 2406-0720 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-bf2ae5e916b8481b9557d5fa4d0a71892025-08-20T02:00:33ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502406-07202016-01-01731889110.2298/VSP141216018J0042-84501500018JFailure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockersJović-Stošić Jasmina0Putić Vesna1Živanović Dragan2Mladenov Milica3Brajković Gordana4Đorđević Snežana5Military Medical Academy, National Poison Control Centre, BelgradeMilitary Medical Academy, National Poison Control Centre, BelgradeMilitary Medical Academy, National Poison Control Centre, BelgradeMilitary Medical Academy, National Poison Control Centre, BelgradeMilitary Medical Academy, National Poison Control Centre, BelgradeMilitary Medical Academy, National Poison Control Centre, BelgradeIntroduction. Calcium channel blockers and beta-blockers are among the most frequently ingested cardiovascular drugs in self-poisoning causing significant mortality. Intravenous lipid emulsion (ILE) is reported as a potentially novel antidote for treatment of acute poisoning caused by some of these drugs. Case report. We presented two cases of poisoning with these drugs. The case 1, a 24-year-old woman ingested amplodipine, metformin and gliclazide for self-poisoning. She presented with tachycardia and hypotension. Laboratory analyses revealed hyperglycaemia and metabolic acidosis. Despite the treatment which included fluid resuscitation, vasopressors, intravenous calcium, glucagon and ILE, circulatory shock occurred. The patient died 10 hours after admission due to cardiac arrest refractory to cardiopulmonary resuscitation. The case 2, a 41-year old man, was found in a coma with empty packages of nifedipine, metoprolol and diazepam tablets. On admission vital signs included Glasgow Coma Scale (GCS) of 3, weak palpable pulses, undetectable blood pressure, and irregular breathing with oxygen saturation of 60%. An electrocardiography showed AV block (Mobitz II) with ventricular rate of 44/min with progression to third degree of AV block. In attempt to increase heart rate and blood pressure the following agents were administered: atropine boluses, normal saline with dopamine, glucagon, calcium chloride and ILE. Temporary transvenous pacemaker was placed, electrical capture was recorded, but without improvement in haemodynamics. Three hours after admission cardiac arrest happened and cardiopulmonary resuscitation was unsuccessful. Conclusion. Intravenous lipid emulsion may be ineffective in acute poisonings with amlodipine, nifedipine or metoprolol.http://www.doiserbia.nb.rs/img/doi/0042-8450/2016/0042-84501500018J.pdfpoisoningsuicidecalcium channel blokersadrenergic beta-antagonistsheart arrestfat emulsions, intravenous |
| spellingShingle | Jović-Stošić Jasmina Putić Vesna Živanović Dragan Mladenov Milica Brajković Gordana Đorđević Snežana Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers Vojnosanitetski Pregled poisoning suicide calcium channel blokers adrenergic beta-antagonists heart arrest fat emulsions, intravenous |
| title | Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers |
| title_full | Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers |
| title_fullStr | Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers |
| title_full_unstemmed | Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers |
| title_short | Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers |
| title_sort | failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers |
| topic | poisoning suicide calcium channel blokers adrenergic beta-antagonists heart arrest fat emulsions, intravenous |
| url | http://www.doiserbia.nb.rs/img/doi/0042-8450/2016/0042-84501500018J.pdf |
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