Atrial Fibrillation with Slow Ventricular Response due to Multi-drug Poisoning - Successful Lipid Emulsion Therapy

Year 2026, Volume: 7 Issue: 3, 66 - 68, 10.01.2026

Nalan Kozacı , Songül Çolak , Ali Kemal Erenler , İhsan Danış , Kenan Türkdoğan

https://doi.org/10.51262/ejtox.1812436

Abstract

In this report, we present a patient with suicidal attempt by multi-drug (Sertraline, quetiapine and Tarka: 240 mg verapamil, 4 mg trandopril) ingestion. The patient developed atrial fibrillation with slow ventricular response, prolongation of QT period and shock. The symptoms of the patient improved dramatically following IV lipid emulsion (ILE) therapy. Any side-effect related to ILE therapy was not determined. ILE therapy may be used in management of patients with fatal cardiotoxicity due to multi-drug intoxication.

Keywords

lipid Emulsion (ILE) Therapy , Multi-drug Poisoning , Atrial Fibrillation , Prolonged QT , Suicide , Multi-drug İntoxication

References

• Jones AW, Kugelberg FC, Holmgren A, Ahlner J. Drug poisoning deaths in Sweden show a predominance of ethanol in mono-intoxications, adverse drug-alcohol interactions and poly-drug use. Forensic Sci Int. 2011;206(1-3):43-51. doi:10.1016/j.forsciint.2010.06.015
• Türkdoğan AK, Aköz A, Avcil M, Çanakçı SE, Duman A. Lipid Emulsion Therapy in Lipophilic or Hydrophilic Drug Intoxication: The Last Weapon in Our Arsenal. Eurasian J Emerg Med. 2019;18(2):90-94. doi:10.4274/eajem. galenos.2018.83584
• Kosenlı O, Satar S, Ay MO, Kosenlı A, Acıkalın A, Kozacı N, et al. Analysıs of Pharmaceutıcal Poısonıngs in Adults Occurred in Adana Regıon of Turkey in North Eastern Medıterranean. Acta Medica Mediterranea, 2014, 30: 585
• Campleman SL, Brent J, Pizon AF, Shulman J, Wax P, Manini AF. Drug-specific risk of severe QT prolongation following acute drug overdose. Clin Toxicol (Phila). 2020;58(12):1326-1334. doi:10.1080/15563650.2020.1746330
• Funk KA, Bostwick JR. A comparison of the risk of QT prolongation among SSRIs. Ann Pharmacother. 2013;47(10):1330-1341. doi:10.1177/1060028013501994
• Chou RH, Lo LW, Liou YJ, Shu JH, Hsu HC, Liang Y, et al. Antipsychotic treatment is associated with risk of atrial fibrillation: A nationwide nested case-control study. Int J Cardiol. 2017;227:134-140. doi:10.1016/j.ijcard.2016.11.185
• Cao Y, Zhou M, Guo H, Zhu W. Associations of Antidepressants With Atrial Fibrillation and Ventricular Arrhythmias: A Systematic Review and Meta-Analysis. Front Cardiovasc Med. 2022;9:840452. Published 2022 Mar 25. doi:10.3389/fcvm.2022.840452
• Alaygut D, Orbatu D , Oflaz MB. Severe Cardiac and Renal Findings in an Adolescent Girl: Trandolapril/Verapamil Hydrochloride Overdose. Tepecik Eğit. ve Araşt. Hast. Dergisi 2019;29(3):302-306
• Havan M, Kendirli T, Özcan S, Doğan MT, Yiğit AO, Uçar T. A successful treatment with intravenous lipid emulsion therapy in a child with verapamil poisoning. Turk J Emerg Med. 2021;21(4):217-220. Published 2021 Oct 29. doi:10.4103/2452-2473.329626
• Bilvanisi S, Gülen M, Sabak M, Demiryürek Ş, Demiryürek AT. Intravenous Lipid Emulsion Therapy in Drug Overdose and Poisoning: An Updated Review. Eurasian J Med. 2024;56(3):205-212. doi:10.5152/eurasianjmed.2024.24510
• Hwang Y, Sohn JT. Effect of lipid emulsion on neuropsychiatric drug-induced toxicity: A narrative review. Medicine (Baltimore).2024;103(11):e37612. doi:10.1097/MD.0000000000037612
• Fettiplace MR, Weinberg G. The Mechanisms Underlying Lipid Resuscitation Therapy. Reg Anesth Pain Med. 2018;43(2):138-149. doi:10.1097/AAP.000000000000071
• Bilvanisi S, Gülen M, Sabak M, Demiryürek Ş, Demiryürek AT. Intravenous Lipid Emulsion Therapy in Drug Overdose and Poisoning: An Updated Review. Eurasian J Med. 2024;56(3):205-212. doi:10.5152/eurasianjmed.2024.24510