scholarly journals Nearly Fatal Hydroxychloroquine Overdose Successfully Treated with Midazolam, Propofol, Sodium Bicarbonate, Norepinephrine, and Intravenous Lipid Emulsion

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Goswin Onsia ◽  
Sarah Bots
Keyword(s):  
Sodium Bicarbonate ◽  
Lipid Emulsion ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Scientific Evidence ◽  
Treatment Options ◽  
Cardiac Monitoring ◽  
High Dose ◽  
Epinephrine Infusion ◽  
Intravenous Lipid Emulsion

Background. In the context of the current COVID-19 pandemic, there has been renewed interest in the drug hydroxychloroquine. However, clinicians should be aware of the dangers of hydroxychloroquine intoxication, an insufficiently studied condition. Case Report. We present a case of autointoxication with 20 g hydroxychloroquine in a 35-year-old woman. Cardiac monitoring showed ventricular arrhythmias for which high-dose midazolam and propofol were initiated, resulting in a brief normalization of the cardiac rhythm. Because of the reoccurrence of these arrhythmias, intravenous lipid emulsion was administered with fast cardiac stabilization. Treatment with continuous norepinephrine, potassium chloride/phosphate, and sodium bicarbonate was initiated. On day 6, she was extubated and after 11 days, she was discharged from the hospital without complications. Conclusion. Since high-quality scientific evidence is lacking, treatment options are based on experience in chloroquine toxicity. Activated charcoal is advised if the patient presents early. Sedation with diazepam, early ventilation, and continuous epinephrine infusion are considered effective in treating severe intoxication. Caution is advised when substituting potassium. Despite the lack of formal evidence, sodium bicarbonate appears to be useful and safe in case of QRS widening. Intravenous lipid emulsion, with or without hemodialysis, remains controversial but appears to be safe. As a last resort, extracorporeal life support might be considered in case of persisting hemodynamic instability.

Venlafaxine Intoxication with Development of Takotsubo Cardiomyopathy: Successful Use of Extracorporeal Life Support, Intravenous Lipid Emulsion and Cytosorb®

2017 ◽  
Vol 40 (7) ◽  
pp. 358-360 ◽  
Author(s):  
Ines Schroeder ◽  
Michael Zoller ◽  
Matthias Angstwurm ◽  
Felix Kur ◽  
Lorenz Frey
Keyword(s):  
Suicide Attempt ◽  
Cardiogenic Shock ◽  
Young Patient ◽  
Takotsubo Cardiomyopathy ◽  
Therapeutic Dose ◽  
Lipid Emulsion ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Intravenous Lipid Emulsion ◽  
Multi Organ Dysfunction Syndrome

We describe a young patient who ingested 18 g (240 times the daily therapeutic dose) of venlafaxine in a suicide attempt. She developed severe cardiomyopathy in a takotsubo distribution causing cardiogenic shock and multi-organ dysfunction syndrome (MODS). She was successfully treated with intravenous lipid emulsion (ILE), extracorporeal life support (ECLS) and CytoSorb®. This is remarkable as, to the best of the authors’ knowledge, this is the highest amount of venlafaxine intake seen in the literature with a nonfatal outcome.

Acute Respiratory Distress Syndrome After Zinc Chloride Inhalation: Survival After Extracorporeal Life Support and Corticosteroid Treatment

2010 ◽  
Vol 19 (1) ◽  
pp. 86-90 ◽  
Author(s):  
Chih-Feng Chian ◽  
Chin-Pyng Wu ◽  
Chien-Wen Chen ◽  
Wen-Lin Su ◽  
Chin-Bin Yeh ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Corticosteroid Treatment ◽  
High Dose ◽  
Arterial Oxygenation ◽  
Bilateral Pneumothorax

No standard protocol exists for the treatment of acute respiratory distress syndrome induced by inhalation of smoke from a smoke bomb. In this case, a 23-year-old man was exposed to smoke from a smoke grenade for approximately 10 to 15 minutes without protective breathing apparatus. Acute respiratory distress syndrome developed subsequently, complicated by bilateral pneumothorax and pneumomediastinum 48 hours after inhalation. Despite mechanical ventilation and bilateral tube thoracostomy, the patient was severely hypoxemic 4 days after hospitalization. His condition improved upon treatment with high-dose corticosteroids, an additional 500-mg dose of methylprednisolone, and the initiation of extracorporeal life support. Arterial oxygenation decreased gradually after abrupt tapering of the corticosteroid dose and discontinuation of the life support. On day 16 of hospitalization, the patient experienced progressive deterioration of arterial oxygenation despite the intensive treatment. The initial treatment regimen (ie, corticosteroids and extracorporeal life support) was resumed, and the patient’s arterial oxygenation improved. The patient survived.

scholarly journals Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics

2021 ◽  
Vol 8 ◽  
Author(s):  
Yang Liu ◽  
Jing Zhang ◽  
Peng Yu ◽  
Jiangfeng Niu ◽  
Shuchun Yu
Keyword(s):  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Life Support ◽  
Clinical Symptoms ◽  
Advanced Cardiac Life Support ◽  
Systemic Toxicity ◽  
The Body ◽  
Research Progress ◽  
Intravenous Lipid Emulsion ◽  
Perioperative Analgesia

Local anesthetics are widely used clinically for perioperative analgesia to achieve comfort in medical treatment. However, when the concentration of local anesthetics in the blood exceeds the tolerance of the body, local anesthetic systemic toxicity (LAST) will occur. With the development and popularization of positioning technology under direct ultrasound, the risks and cases of LAST associated with direct entry of the anesthetic into the blood vessel have been reduced. Clinical occurrence of LAST usually presents as a series of severe toxic reactions such as myocardial depression, which is life-threatening. In addition to basic life support (airway management, advanced cardiac life support, etc.), intravenous lipid emulsion (ILE) has been introduced as a treatment option in recent years and has gradually become the first-line treatment for LAST. This review introduces the mechanisms of LAST and identifies the clinical symptoms displayed by the central nervous system and cardiovascular system. The paper features the multimodal mechanism of LAST reversal by ILE, describes research progress in the field, and identifies other anesthetics involved in the resuscitation process of LAST. Finally, the review presents key issues in lipid therapy. Although ILE has achieved notable success in the treatment of LAST, adverse reactions and contraindications also exist; therefore, ILE requires a high degree of attention during use. More in-depth research on the treatment mechanism of ILE, the resuscitation dosage and method of ILE, and the combined use with other resuscitation measures is needed to improve the efficacy and safety of clinical resuscitation after LAST in the future.

Vitamin D deficiency cardiomyopathy in Scotland: a retrospective review of the last decade

2020 ◽  
Vol 105 (9) ◽  
pp. 853-856
Author(s):  
Lindsay Hunter ◽  
Richard Ferguson ◽  
Helen McDevitt
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Retrospective Review ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Case Series ◽  
High Serum ◽  
High Dose ◽  
Cardiac Transplant ◽  
Total Body Calcium

ObjectiveTo determine the incidence, demography and prognosis of vitamin D deficiency dilated cardiomyopathy (DCM) in Scotland over the last decade.Study designA retrospective review of cases of vitamin D deficiency DCM presenting to a national paediatric cardiac centre between 1 January 2008 and 1 January 2018. The departmental database and electronic and paper case notes were used to identify patients and extract data.ResultsSix patients were identified (three male), three of whom were Caucasian. Median age at presentation was 206 days (range 2–268.) All six patients had high serum parathyroid hormone levels (median 45 pmol/L, range 27–120 pmol/L), a sensitive marker of total body calcium deprivation secondary to vitamin D deficiency. All patients demonstrated clinical and echocardiographic improvement following high dose vitamin D treatment. No patients required cardiac transplant, and only one patient required extracorporeal life support as a bridge to recovery. After an initial improvement, one child died at 5 months as a result of respiratory infection. Three patients lived within some of the most deprived areas in Scotland.ConclusionsThis case series demonstrates a previously unreported demographic in Scotland, as 50% of cases presented in Caucasian children. Although vitamin D deficiency DCM is relatively rare, it is wholly preventable. Our study confirms that vitamin D deficiency cardiomyopathy is reversible with prompt identification and supplementation. The current implementation of public health policy in the UK is failing to prevent children from developing the most severe manifestation of vitamin D deficiency.

scholarly journals Rituximab Induced Pulmonary Edema Managed with Extracorporeal Life Support

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Jacob R. Miller ◽  
Warren Isakow ◽  
Muhammad F. Masood ◽  
Patrick Aguilar ◽  
Kristen M. Sanfilippo ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Pulmonary Edema ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Respiratory Acidosis ◽  
High Dose ◽  
Thrombocytopenic Purpura ◽  
Cardiorespiratory Failure ◽  
Severe Pulmonary Edema

Though rare, rituximab has been reported to induce severe pulmonary edema. We describe the first report of ECLS utilization for this indication. A 31-year-old female with severe thrombotic thrombocytopenic purpura developed florid pulmonary edema after rituximab infusion. Despite advanced ventilatory settings, she developed severe respiratory acidosis and remained hypoxemic with a significant vasopressor requirement. Since her pulmonary insult was likely transient, ECLS was considered. Due to combined cardiorespiratory failure, she received support with peripheral venoarterial ECLS. During her ECLS course, she received daily plasmapheresis and high dose steroids. Her pulmonary function recovered and she was decannulated after 8 days. She was discharged after 23 days without residual sequelae.

Tilmicosin toxicity: a case of accidental human tilmicosin injection managed with calcium, high-dose insulin and intravenous lipid emulsion therapy

2016 ◽  
Vol 54 (8) ◽  
pp. 812-813
Author(s):  
Floyd Besserer ◽  
Ryan Chuang ◽  
Matt Mink ◽  
Laurie Massey ◽  
Bruce Cload
Keyword(s):  
Lipid Emulsion ◽  
High Dose ◽  
Intravenous Lipid Emulsion

scholarly journals Extracorporeal life support: The final ‘antidote’ for massive propranolol overdose

2018 ◽  
Vol 26 (2) ◽  
pp. 118-123 ◽  
Author(s):  
Liang-Wen Chen ◽  
Desmond Renhao Mao ◽  
Yih-Sharng Chen
Keyword(s):  
Plasma Exchange ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Drug Clearance ◽  
Spontaneous Circulation ◽  
Therapeutic Plasma Exchange ◽  
Neurological Deficits ◽  
High Dose ◽  
Refractory Hypotension ◽  
Propranolol Overdose

Massive propranolol overdose may result in severe cardiotoxicity. A 48-year-old female had consumed more than 5000 mg of propranolol. Despite high-dose insulin, intravenous sodium bicarbonate, glucagon and inotropic support, she became hypotensive and subsequently arrested. Following cardiopulmonary resuscitation, she had a return of spontaneous circulation but continued to experience refractory hypotension. Resuscitation continued with veno-arterial extracorporeal life support. Therapeutic plasma exchange was initiated to shorten time on extracorporeal life support. Extracorporeal life support was weaned off within 67 h, and she survived without neurological deficits. This records the largest propranolol overdose in recent years. When traditional antidotes are insufficient to prevent collapse, extracorporeal life support is a salvage therapy to maintain perfusion and reduce vasopressor requirements. As drug clearance is significantly prolonged, therapeutic plasma exchange can enhance removal of propranolol and reduce the time to extracorporeal life support removal. With increasing expertise and availability, extracorporeal life support should be considered early in patients who have overdosed with significant cardiotoxicity.

Sign in / Sign up

Export Citation Format

Share Document