Citation

Markota A, Hajdinjak E, Rupnik B, Sinkovič A. Signa Vitae 2015; 10(1): 144-150.

Copyright

(Copyright © 2015, Pharmamed Mado)

DOI

10.22514/SV101.042015.12

PMID

unavailable

Abstract

Background. Treatment of combined beta blocker and calcium channel blocker intoxication remains challenging due to a profound and treatment-resistant circulatory collapse. Along with standard therapy (calcium, glucagon, mechanical ventilation, vasopressors), two novel approaches are increasingly being reported as successful: hyperinsulinemic euglycemia and intravenous lipid emulsion. Case Report. Our patient: a 66-year-old Caucasian male who ingested approximately 450 mg of bisoprolol, 300 mg of amlodipine, 200 mg of doxazosin and smaller amounts of nifedipine, torasemide, acetysaliclic acid and ibuprofen in a suicide attempt. The patient was hypotensive and bradycardic on admission with left-ventricular ejection fraction estimated at 10-15%. By combining standard therapy (intubation, mechanical ventilation, vasopressors, calcium and glucagon) and new therapies (hyperinsulinemic euglycemia and intravenous lipid emulsions) in a stepwise approach we normalized systolic function and treated bradycardiawithin 2 hours of admission. However, severe hypotension persisted requiring extremely high doses of norepinephrine (14 mcg/kg/min) and vasopressin (0.03 U/min) to maintain his blood pressure over the following three days. He was discharged home after prolonged in-hospital treatment and rehabilitation (62 days) and extensive physical and psychiatric rehabilitation. Why should an emergency physician be aware of this? Aggressive medical therapy including hyperinsulinemic euglycemia, intravenous lipid emulsions and high doses of norepinephrine could be considered for multidrug intoxication with a predominant clinical picture of beta blocker and calcium channel blocker intoxication in patients presenting with severe hemodynamic compromise. © 2015, Pharmamed Mado Ltd. All rights reserved.

Language: en

Keywords

human; male; Poisoning; aged; case report; suicide attempt; disease severity; drug intoxication; hospital admission; noradrenalin; acetylsalicylic acid; activated carbon; drug fatality; beta adrenergic receptor blocking agent; hypotension; drug megadose; artificial ventilation; physiotherapy; adrenalin; endotracheal intubation; ibuprofen; calcium channel blocking agent; blood pressure regulation; dobutamine; gluconate calcium; glucagon; bradycardia; treatment response; vasopressin; Article; doxazosin; systolic blood pressure; drug dose increase; heart left ventricle ejection fraction; treatment duration; continuous infusion; amlodipine; nifedipine; rehabilitation care; lipid emulsion; bisoprolol; Complementary therapies; Emergency treatment; hyperinsulinemic euglycemia; torasemide