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15.09.2016 | Originalien

Intravenous lipid emulsion therapy in calcium channel blocker and beta-blocker poisoning

verfasst von: Y. K. Günaydın, M.D, O. Özelbaykal, H. Ş. Akça, N. Muraçar, N. B. Akıllı, R. Köylü, B. Cander

Erschienen in: Notfall + Rettungsmedizin

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Abstract

Background

Intravenous lipid emulsion (ILE) therapy is recommended for the treatment of poisoned patients with cardiovascular collapse secondary to lipophilic drug poisoning, e.g., beta blockers (BB) and calcium channel blockers (CCB).

Objective

We aimed to present our experiences with ILE therapy in CCB and BB poisoning.

Method

Our emergency medicine clinic has a toxicology intensive care unit for patients who require hospitalization and follow-up because of unintentional or suicidal attempt intoxication. A total of five patients with intoxication were hospitalized in our toxicology intensive care unit sequentially between March 2014 and March 2015. Data for this case series were obtained by screening the patient files.

Case reports

Our study comprises five case reports: three CCB and two BB poisoning. We gave ILE treatment to patients who were unresponsive to routine CCB and BB poisoning therapy. After ILE treatment, three of the five patients were discharged from hospital and the other two died. We observed that ILE therapy had positive effects on three of the patients’ hemodynamic parameters and vital signs. For two of the patients, however, the treatment did not have a positive impact on blood pressure and heart rate. After ILE treatment, only one patient had lipemia and pleural effusion as a secondary complication of therapy.

Conclusion

ILE therapy can be effective in the treatment of CCB and BB drug poisoning.

Weinberg G, VadeBoncouer T, Ramaraju G, Garcia-Amaro M, Cwik M (1998) Pretreatment or resuscitation with a lipid infusion shifts the dose–response to bupivacaine-induced asystole in rats. Anaesthesiology 88:1071–1075CrossRef

Stellpflug SJ et al (2010) Intentional overdose with cardiac arrest treated with intravenous fat emulsion and high-dose insulin. Clin Toxicol (Phila) 48(3):227–229CrossRef

French D et al (2011) Serum verapamil concentrations before and after Intralipid® therapy during treatment of an overdose. Clin Toxicol (Phila) 49(4):340–344CrossRef

LipidRescue™ Resuscitation … for drug toxicity. 2013; Available at: http://www.lipidrescue.org/. Accessed November 1, 2013. (Website)

Young AC et al (2009) Intravenous fat emulsion therapy for intentional sustained-release verapamil overdose. Resuscitation 80(5):591–593CrossRefPubMed

Vanden Hoel TL, Morrison LJ, Shuster M (2010) Cardiac arrest in special situations. Circulation 122:S829–S861CrossRef

Holger JS, Stellpflug SJ, Cole JB, Harris CR, Engebretsen KM (2011) High-dose insulin: a consecutive case series in toxin-induced cardiogenic shock. Clin Toxicol (Phila) 49:653–658CrossRef

Jamaty C, Bailey B, Larocque A, Notebaart E, Sanogo K, Chauny JM (2010) Lipid emulsions in the treatment of acute poisoning: a systematic review of human and animal studies. Clin Toxicol (Phila) 48:1–27CrossRef

Stellpflug SJ, Harris CR, Engebretsen KM, Cole JB, Holger JS (2010) Intentional overdose with cardiac arrest treated with intravenous fat emulsion and high-dose insulin. Clin Toxicol (Phila) 48:227–229CrossRef

10.

Engebretsen KM, Kaczmarek KM, Morgan J, Holger JS (2011) High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning. Clin Toxicol (Phila) 49:277–283CrossRef

11.

Holger JS, Engebretsen KM, Marini JJ (2009) High dose insulin in toxic cardiogenic shock. Clin Toxicol (Phila) 47:303–307CrossRef

12.

Salhanick SD, Shannon MW (2003) Management of calcium channel antagonist overdose. Drug Saf 26:65–79CrossRefPubMed

13.

Newton CR, Delgado JH, Gomez HF (2002) Calcium and beta receptor antagonist overdose: a review and update of pharmacological principles and management. Semin Respir Crit Care Med 23:19–25CrossRefPubMed

14.

Doepker B, Healy W, Cortez E, Adkins EJ (2014) High-dose insulin and intravenous lipid emulsion therapy for cardiogenic shock induced by intentional calcium-channel blocker and Beta-blocker overdose: a case series. J Emerg Med 46(4):486–490CrossRefPubMed

15.

DeWitt CR, Waksman JC (2004) Pharmacology, pathophysiology and management of calcium channel blocker and beta – blocker toxicity. Toxicol Rev 23(4):223–238CrossRefPubMed

16.

Kerns W (2007) Management of beta – adrenergic blocker and calcium channel antagonist toxicity. Emerg Med Clin North Am 25(2):309–331CrossRefPubMed

17.

Krieglstein J, Meffert A, Niemeyer D (1974) Influence of emulsified fat on chlorpromazine availability in rabbit blood. Cell Mol Life Sci 30:924–926CrossRef

18.

Dissanayke M, Doery J, Graudins A (2010) Development of an in-vitro protocol to test for potential benefit of intravenous fat emulsion therapy for drug overdose. Clin Biochem Rev 31(4):s7–s52

19.

Harvey M, Cave G (2007) Intralipid outperforms sodium bicarbonate in a rabbit model of clomipramine toxicity. Ann Emerg Med 49:178–185CrossRefPubMed

20.

Tebbutt S, Harvey M, Nicholson T, Cave G (2008) Intralipid prolongs survival in a rat model of verapamil toxicity. Acad Emerg Med 13:134–139CrossRef

21.

Stehr SN, Pexa A, Hannack S, Heintz A (2007) The effects of lipid infusion on myocardial function and bioenergetics in l‑bupivacaine toxicity in the isolated rat heart. Anesth Analg (Paris) 104:186–192CrossRef

22.

Fettiplace MR, Ripper R, Lis K, Lin B (2013) Rapid cardiotonic effects of lipid emulsion infusion. Crit Care Med 41(8):e156–62CrossRefPubMed

23.

Gueret G, Pennec JP, Arvieux CC (2007) Haemodynamic effects of intralipid after verapamil intoxication may be due to a direct effect of fatty acids on myocardial calcium channels [Letter]. Acad Emerg Med 14(8):761CrossRefPubMed

24.

ACMT (2011) ACMT position statement: interim guidance for the use of lipid resuscitation therapy. J Med Toxicol 7(1):81–82CrossRef

25.

Garrett R, Kaura V, Kathawaroo S (2013) Intravenous lipid emulsion therapy. Trends Anaesth Crit Care 3:336–341CrossRef

26.

Browne A, Harvey M, Cave G (2010) Intravenous lipid emulsion does not augment blood pressure recovery in a rabbit model of metoprolol toxicity. J Med Toxicol. doi:10.1007/s13181-010-0049-y PubMedPubMedCentral

27.

Cave G, Harvey M, Castle C (2006) The role of fat emulsion therapy in a rodent model of propranolol toxicity: a preliminary study. J Med Toxicol 2:4–7CrossRefPubMedPubMedCentral

28.

Harvey M, Cave G (2008) Intralipid infusion ameliorates propranolol induced hypotension in rabbits. J Med Toxicol 4:71–76CrossRefPubMedPubMedCentral

29.

Bania T, Chu J, Perez E (2007) Hemodynamic effects of intravenous fat emulsion in an animal model of severe verapamil toxicity resuscitated with atropine, calcium, and saline. Acad Emerg Med 14:105–111CrossRefPubMed

30.

Cave G, Harvey M, Graudins A (2011) Intravenous lipid emulsion as antidote: a summary of published human experience. Emerg Med Australas 23(2):123–141CrossRefPubMed

31.

Liang CW, Diamond SJ, Hagg DS (2011) Lipid rescue of massive verapamil overdose: a case report. J Med Case Rep 5:399–404CrossRefPubMedPubMedCentral

32.

Geib A, Manini A, Liebelt E (2009) Case series of intravenous lipid emulsion rescue for drug cardiotoxicity [abstract. Clin Toxicol 47:704

33.

West P, McKeown N, Hendrickson R (2010) Iatrogenic lipid emulsion overdose in a case of amlodipine poisoning. Clin Toxicol 48:393–396CrossRef

34.

Orr K, Bailie R (2010) The use of Intralipid in the management of a mixed overdose. J Intens Care Soc 11:268–269CrossRef

35.

Montiel V, Gougnard T, Hanston P (2011) Diltiazem poisoning treated with hyperinsulinaemic euglycaemia therapy and intravenous lipid emulsion. Eur J Emerg Med 18(2):121–123CrossRefPubMed

36.

Cave G, Harvey M (2009) Lipid emulsion may augment early blood pressure recovery in a rabbit model of atenolol toxicity. J Med Toxicol 5:50–51CrossRefPubMedPubMedCentral

37.

Harchelroad F, Palma A (2008) Efficacy and safety of intravenous lipid therapy in a B‑blocker overdose. Clin Toxicol (Phila) 46:620

38.

Carr D, Boone A, Hoffman RS, Martin K, Ahluwalia N (2009) Successful resuscitation of a carvedilol overdose using intravenous fat emulsion (IFE). Clin Toxicol 47:727

Titel: Intravenous lipid emulsion therapy in calcium channel blocker and beta-blocker poisoning
verfasst von: Y. K. Günaydın, M.D
O. Özelbaykal
H. Ş. Akça
N. Muraçar
N. B. Akıllı
R. Köylü
B. Cander
Publikationsdatum: 15.09.2016
Verlag: Springer Medizin
Erschienen in: Notfall + Rettungsmedizin
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI: https://doi.org/10.1007/s10049-016-0225-y