Citation

Galiero F, Consani G, Biancofiore G, Ruschi S, Forfori F. Am. J. Emerg. Med. 2018; 36(2): 341.e5-341.e6.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.ajem.2017.10.057

PMID

29089189

Abstract

Vasopressin is a potent vasopressor used for improving organ perfusion during cardiac arrest, septic and catecholamine-resistant shock; with reference to this, it is useful for the treatment of vasoplegic shock because, restoring organ perfusion pressure by contraction of vascular smooth muscle through a non-catecholamine receptor pathway, it can be employed when catecholamines are ineffective. A 49-yr-old woman was admitted to the Emergency Department after having intentionally taken 95.2g of metformin, 1.6g of pioglitazone and 40 UI of insulin glargine in a suicide attempt. Despite fluid resuscitation, CVVHDF (continuous veno-venous hemodiafiltration) treatment, norepinephrine and epinephrine infusion, she developed a severe lactic acidosis and a catecholamines-refractive vasodilatory shock. Only the vasopressin infusion, in association with catecholamines, gradually stabilized the patient's hemodynamic status.

Language: en

Keywords

Humans; Female; Middle Aged; Severity of Illness Index; Hypoglycemic Agents; Hemodynamics; Metformin; Vasopressins; Acidosis, Lactic; Vasoconstrictor Agents