tailieunhanh - báo cáo khoa học: "Lipid rescue of massive verapamil overdose: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Lipid rescue of massive verapamil overdose: a case report | Liang et al. Journal of Medical Case Reports 2011 5 399 http content 5 1 399 JOURNALOF medical case reports CASE REPORT Open Access Lipid rescue of massive verapamil overdose a case report Conrad W Liang1 Sarah J Diamond2 and Daniel S Hagg2 Abstract Introduction Massive intentional verapamil overdose is a toxic ingestion which can cause multiorgan system failure and has no currently known antidote. Case Presentation The patient is a 41-year-old Caucasian woman who ingested g of sustained release verapamil in a suicide attempt. Our patient became hypotensive requiring three high-dose vasopressors to maintain arterial pressure. She also developed acute respiratory failure bradycardic ventricular rhythm necessitating continuous transvenous pacing and anuric renal failure. Our patient was treated with intravenous calcium bicarbonate hyperinsulinemic euglycemic therapy and continuous venovenous hemodialysis without success. On the fourth day after hospital admission continuous intravenous lipid therapy was initiated. Within three hours of beginning lipid therapy our patient s vasopressor requirement decreased by half. Within 24 hours she was on minimal vasopressor support and regained an underlying junctional rhythm. After three days of lipid infusion she no longer required inotropic agents to maintain blood pressure or pacing to maintain stable hemodynamics. Conclusions Intravenous fat emulsion therapy may be an effective antidote for massive verapamil toxicity. Introduction Calcium channel blockers are commonly prescribed for hypertension and rate control of atrial fibrillation but can be highly toxic in large quantities. Massive overdose of these medications is a serious clinical problem seen rarely in the intensive care unit management is typically supportive with variable rates of success 1-4 . Here we report the successful use of intravenous lipid therapy to reverse the systemic effects of severe verapamil toxicity and we review .