Introduction. Calcium channel blockers and beta-blockers are among the most
frequently ingested cardiovascular drugs in self-poisoning causing
significant mortality. Intravenous lipid emulsion (ILE) is reported as a
potentially novel antidote for treatment of acute poisoning caused by some of
these drugs. Case report. We presented two cases of poisoning with these
drugs. The case 1, a 24-year-old woman ingested amplodipine, metformin and
gliclazide for self-poisoning. She presented with tachycardia and
hypotension. Laboratory analyses revealed hyperglycaemia and metabolic
acidosis. Despite the treatment which included fluid resuscitation,
vasopressors, intravenous calcium, glucagon and ILE, circulatory shock
occurred. The patient died 10 hours after admission due to cardiac arrest
refractory to cardiopulmonary resuscitation. The case 2, a 41-year old man,
was found in a coma with empty packages of nifedipine, metoprolol and
diazepam tablets. On admission vital signs included Glasgow Coma Scale (GCS)
of 3, weak palpable pulses, undetectable blood pressure, and irregular
breathing with oxygen saturation of 60%. An electrocardiography showed AV
block (Mobitz II) with ventricular rate of 44/min with progression to third
degree of AV block. In attempt to increase heart rate and blood pressure the
following agents were administered: atropine boluses, normal saline with
dopamine, glucagon, calcium chloride and ILE. Temporary transvenous pacemaker
was placed, electrical capture was recorded, but without improvement in
haemodynamics. Three hours after admission cardiac arrest happened and
cardiopulmonary resuscitation was unsuccessful. Conclusion. Intravenous lipid
emulsion may be ineffective in acute poisonings with amlodipine, nifedipine
or metoprolol.
Intravenous lipid-emulsion therapy in a patient with cardiac arrest after overdose of diphenhydramine
