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Verapamil Zehirlenmesi, İntravenöz Lipid Tedavisinin Önemi: Olgu Sunumu

Year 2013, Volume: 4 Issue: 3, 130 - 132, 01.07.2013

Emine Akıncı Ramazan Köylü

Abstract

İntravenöz lipid emülsiyon (İLE) tedavisi son yıllarda başta lokal
anestezik ilaç toksisistesi olmak üzere lipofilik olan ilaç zehirlenmelerinde
etkin bir antidot olarak kullanılmaktadır. Aşırı doz verapamil
alımı, multi organ yetmezliğine yol açabilecek ve kanıtlanmış
antidot tedavisi olmayan, ölümcül olabilen zehirlenmelere
yol açabilir. Kalsiyum kanal blokörlerine (KKB) bağlı zehirlenmelerin
tedavisinde dekontaminasyon, sıvı replasmanı, vasopressör
ajanlar, glukagon yer almaktadır. Biz agresif tedaviye rağmen hipotansiyonları
devam eden intravenöz lipid desteği sonucu başarı
ile resüsite ettiğimiz hastamızı sunuyoruz.

Keywords

Verapamil intravenöz lipid tedavisi zehirlenme

References

  • Rothschild L, Bern S, Oswald S, Weinberg G. Intravenous lipid emulsion in clinical toxicology. Scand J Trauma Resusc Emerg Med 2010; 18: 51. [CrossRef]
  • Liang CW, Diamond SJ, Hagg DS. Lipid rescue of massive verapamil overdose: a case report. J Med Case Rep 2011; 5: 399. [CrossRef]
  • Newton CR, Delgado JH, Gomez HF. Calcium and beta receptor antagonist overdose: a review and update of pharmacological principles and management. Semin Respir Crit Care Med 2002; 23: 19-25. [CrossRef]
  • Zimmerman JL. Poisonings and overdoses in the intensive care unit: general and specific management issues. Crit Care Med 2003; 31: 2794-801. [CrossRef]
  • Sim MT, Stevenson FT. A fatal case of iatrogenic hypercalcemia after calcium channel blocker overdose. J Med Toxicol 2008; 4: 25-9. [CrossRef]
  • Ezidiegwu C, Spektor Z, Nasr MR, Kelly KC, Rosales LG. A case report on the role of plasma exchange in the management of a massive amlodipine besylate intoxication. Ther Apher Dial 2008; 12: 180-4. [CrossRef]
  • Pfaender M, Casetti PG, Azzolini M, Baldi ML, Valli A. Successful treatment of a massive atenolol and nifedipine overdose with CVVHDF. Minerva Anestesiol 2008; 74: 97-100.
  • Greene SL, Gawarammana I, Wood DM, Jones AL, Dargan PI. Relative safety of hyperinsulinaemia/euglycaemia therapy in the management of calcium channel blocker overdose: a prospective observational study. Intensive Care Med 2007; 33: 2019-24. [CrossRef]
  • Patel NP, Pugh ME, Goldberg S, Eiger G. Hyperinsulinemic euglycemia therapy for verapamil poisoning: case report. Am J Crit Care 2007; 16: 518-9.
  • Montiel V, Gougnard T, Hantson P. Diltiazem poisoning treated with hyperinsulinemic euglycemia therapy and intravenous lipid emulsion. Eur J Emerg Med 2011; 18: 121-3. [CrossRef]
  • Tebbutt S, Harvey M, Nicholson T, Cave G. Intralipid prolongs survival in a rat model of verapamil toxicity. Acad Emerg Med 2006; 13: 134-9. [CrossRef]
  • Perez E, Bania TC, Medlej K, Chu J. Determining the optimal dose of intravenous fat emulsion for the treatment of severe verapamil toxicity in a rodent model. Acad Emerg Med 2008; 15: 1284-9. [CrossRef]
  • Bania TC, Chu J, Perez E, Su M, Hahn IH. Hemodynamic effects of intravenous fat emulsion in an animal model of severe verapamil toxicity resuscitated with atropine, calcium, and saline. Acad Emerg Med 2007; 14: 105-11. [CrossRef]
  • Young AC, Velez LI, Kleinschmidt KC. Intravenous fat emulsion therapy for intentional sustained-release verapamil overdose. Resuscitation 2009; 80: 591-3. [CrossRef]
  • Jamaty C, Bailey B, Larocque A, Notebaert E, Sanogo K, Chauny JM. Lipid emulsions in the treatment of acute poisoning: a systematic review of human and animal studies. Clin Toxicol (Phila) 2010; 48: 1-27. [CrossRef]
  • Cave G, Harvey M. Intravenous lipid emulsion as antidote beyond local anesthetic toxicity: a systematic review. Acad Emerg Med 2009; 16: 815- 24. [CrossRef]
  • Leskiw U, Weinberg GL. Lipid resuscitation for local anesthetic toxicity: is it really lifesaving? Curr Opin Anaesthesiol 2009; 22: 667-71. [CrossRef]
  • French D, Armenian P, Ruan W, Wong A, Drasner K, Olson KR, et al. Serum verapamil concentrations before and after Intralipid® therapy during treatment of an overdose. Clin Toxicol (Phila) 2011; 49: 340-4. [CrossRef]
  • Weinberg GL. Treatment of local anesthetic systemic toxicity (LAST). Reg Anesth Pain Med 2010; 35: 188-93. [CrossRef]

Verapamil Poisoning, the Importance of Intravenous Lipid Therapy: Case Report

Year 2013, Volume: 4 Issue: 3, 130 - 132, 01.07.2013

Emine Akıncı Ramazan Köylü

Abstract

In recent years, intravenous lipid emulsions (ILE) have been used as an effective antidote to lipophilic drug poisonings, especially to local anaesthetic drug intoxication. Massive intentional verapamil overdose is a toxic ingestion that can cause multiorgan failure and currently has no known antidote, which can lead to fatal poisoning. Treatments for calcium channel blocker (CCB) intoxications include decontamination, fluid replacement, vasopressors and glucagon. Here, we present a patient who showed continued hypotension despite aggressive treatment but was successfully resuscitated following intravenous lipid support

Keywords

Verapamil intra-venous lipid therapy intoxication

References

  • Rothschild L, Bern S, Oswald S, Weinberg G. Intravenous lipid emulsion in clinical toxicology. Scand J Trauma Resusc Emerg Med 2010; 18: 51. [CrossRef]
  • Liang CW, Diamond SJ, Hagg DS. Lipid rescue of massive verapamil overdose: a case report. J Med Case Rep 2011; 5: 399. [CrossRef]
  • Newton CR, Delgado JH, Gomez HF. Calcium and beta receptor antagonist overdose: a review and update of pharmacological principles and management. Semin Respir Crit Care Med 2002; 23: 19-25. [CrossRef]
  • Zimmerman JL. Poisonings and overdoses in the intensive care unit: general and specific management issues. Crit Care Med 2003; 31: 2794-801. [CrossRef]
  • Sim MT, Stevenson FT. A fatal case of iatrogenic hypercalcemia after calcium channel blocker overdose. J Med Toxicol 2008; 4: 25-9. [CrossRef]
  • Ezidiegwu C, Spektor Z, Nasr MR, Kelly KC, Rosales LG. A case report on the role of plasma exchange in the management of a massive amlodipine besylate intoxication. Ther Apher Dial 2008; 12: 180-4. [CrossRef]
  • Pfaender M, Casetti PG, Azzolini M, Baldi ML, Valli A. Successful treatment of a massive atenolol and nifedipine overdose with CVVHDF. Minerva Anestesiol 2008; 74: 97-100.
  • Greene SL, Gawarammana I, Wood DM, Jones AL, Dargan PI. Relative safety of hyperinsulinaemia/euglycaemia therapy in the management of calcium channel blocker overdose: a prospective observational study. Intensive Care Med 2007; 33: 2019-24. [CrossRef]
  • Patel NP, Pugh ME, Goldberg S, Eiger G. Hyperinsulinemic euglycemia therapy for verapamil poisoning: case report. Am J Crit Care 2007; 16: 518-9.
  • Montiel V, Gougnard T, Hantson P. Diltiazem poisoning treated with hyperinsulinemic euglycemia therapy and intravenous lipid emulsion. Eur J Emerg Med 2011; 18: 121-3. [CrossRef]
  • Tebbutt S, Harvey M, Nicholson T, Cave G. Intralipid prolongs survival in a rat model of verapamil toxicity. Acad Emerg Med 2006; 13: 134-9. [CrossRef]
  • Perez E, Bania TC, Medlej K, Chu J. Determining the optimal dose of intravenous fat emulsion for the treatment of severe verapamil toxicity in a rodent model. Acad Emerg Med 2008; 15: 1284-9. [CrossRef]
  • Bania TC, Chu J, Perez E, Su M, Hahn IH. Hemodynamic effects of intravenous fat emulsion in an animal model of severe verapamil toxicity resuscitated with atropine, calcium, and saline. Acad Emerg Med 2007; 14: 105-11. [CrossRef]
  • Young AC, Velez LI, Kleinschmidt KC. Intravenous fat emulsion therapy for intentional sustained-release verapamil overdose. Resuscitation 2009; 80: 591-3. [CrossRef]
  • Jamaty C, Bailey B, Larocque A, Notebaert E, Sanogo K, Chauny JM. Lipid emulsions in the treatment of acute poisoning: a systematic review of human and animal studies. Clin Toxicol (Phila) 2010; 48: 1-27. [CrossRef]
  • Cave G, Harvey M. Intravenous lipid emulsion as antidote beyond local anesthetic toxicity: a systematic review. Acad Emerg Med 2009; 16: 815- 24. [CrossRef]
  • Leskiw U, Weinberg GL. Lipid resuscitation for local anesthetic toxicity: is it really lifesaving? Curr Opin Anaesthesiol 2009; 22: 667-71. [CrossRef]
  • French D, Armenian P, Ruan W, Wong A, Drasner K, Olson KR, et al. Serum verapamil concentrations before and after Intralipid® therapy during treatment of an overdose. Clin Toxicol (Phila) 2011; 49: 340-4. [CrossRef]
  • Weinberg GL. Treatment of local anesthetic systemic toxicity (LAST). Reg Anesth Pain Med 2010; 35: 188-93. [CrossRef]
There are 19 citations in total.

Details

Other ID JA58RZ38NP
Journal Section Case Report
Authors

Emine Akıncı This is me

Ramazan Köylü This is me

Publication Date July 1, 2013
Submission Date July 1, 2013
Published in Issue Year 2013 Volume: 4 Issue: 3

Cite

APA Akıncı, E., & Köylü, R. (2013). Verapamil Poisoning, the Importance of Intravenous Lipid Therapy: Case Report. Journal of Emergency Medicine Case Reports, 4(3), 130-132.
AMA Akıncı E, Köylü R. Verapamil Poisoning, the Importance of Intravenous Lipid Therapy: Case Report. Journal of Emergency Medicine Case Reports. July 2013;4(3):130-132.
Chicago Akıncı, Emine, and Ramazan Köylü. “Verapamil Poisoning, the Importance of Intravenous Lipid Therapy: Case Report”. Journal of Emergency Medicine Case Reports 4, no. 3 (July 2013): 130-32.
EndNote Akıncı E, Köylü R (July 1, 2013) Verapamil Poisoning, the Importance of Intravenous Lipid Therapy: Case Report. Journal of Emergency Medicine Case Reports 4 3 130–132.
IEEE E. Akıncı and R. Köylü, “Verapamil Poisoning, the Importance of Intravenous Lipid Therapy: Case Report”, Journal of Emergency Medicine Case Reports, vol. 4, no. 3, pp. 130–132, 2013.
ISNAD Akıncı, Emine - Köylü, Ramazan. “Verapamil Poisoning, the Importance of Intravenous Lipid Therapy: Case Report”. Journal of Emergency Medicine Case Reports 4/3 (July 2013), 130-132.
JAMA Akıncı E, Köylü R. Verapamil Poisoning, the Importance of Intravenous Lipid Therapy: Case Report. Journal of Emergency Medicine Case Reports. 2013;4:130–132.
MLA Akıncı, Emine and Ramazan Köylü. “Verapamil Poisoning, the Importance of Intravenous Lipid Therapy: Case Report”. Journal of Emergency Medicine Case Reports, vol. 4, no. 3, 2013, pp. 130-2.
Vancouver Akıncı E, Köylü R. Verapamil Poisoning, the Importance of Intravenous Lipid Therapy: Case Report. Journal of Emergency Medicine Case Reports. 2013;4(3):130-2.