scholarly journals Case Report: Colchicine Toxicokinetic Analysis in a Poisoned Child Requiring Extracorporeal Life Support

2021 ◽  
Vol 9 ◽  
Author(s):  
Maria Pérez Marín ◽  
Sylvain Prod'hom ◽  
Suzanne Francesca de Villiers ◽  
Thomas Ferry ◽  
Vivianne Amiet ◽  
...  
Keyword(s):  
Organ Failure ◽  
Activated Charcoal ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Blood Levels ◽  
Renal Elimination ◽  
Close Monitoring ◽  
Small Contribution ◽  
Multi Organ Failure ◽  
Colchicine Poisoning

Colchicine poisoning is associated with a poor prognosis, especially when leading to shock and multi-organ failure, and management is limited to supportive care, including multiple-dose activated charcoal. At therapeutic concentrations, colchicine elimination occurs mainly through hepatic metabolism and involves an enterohepatic circulation, with a small contribution of renal elimination (10–30%). Colchicine toxicokinetics is however rarely described, especially in children. We present the case of a 4-year-old patient who survived a severe iatrogenic colchicine intoxication with a dose of 0.5 mg/kg. She developed multi-organ failure and shock, but recovered after receiving aggressive resuscitation, including extracorporeal life support. Close monitoring of colchicine blood levels showed a plateau for 6 days, indicating impeded elimination resulting from liver failure. We observed no significant clearance from renal replacement therapy, nor activated charcoal, during this period. Extracorporeal life support may play a supportive role in the management of severe colchicine poisoning. However, extracorporeal techniques do not seem to improve colchicine elimination.

scholarly journals The Use of Extracorporeal Life Support in a Patient Suffering from Venlafaxine Intoxication. A Case Report

2020 ◽  
Vol 6 (2) ◽  
pp. 120-123
Author(s):  
Christoph Marquetand ◽  
Harald F. Langer ◽  
Jan Philipp Klein ◽  
Tobias Graf
Keyword(s):  
Case Report ◽  
Organ Failure ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Full Recovery ◽  
Cardiac Complications ◽  
Multi Organ Failure ◽  
Noradrenaline Reuptake ◽  
Bridging Strategy

AbstractVery few reports exist on serious cardiac complications associated with intake of serotonin-noradrenaline reuptake inhibitors. This paper describes and discusses the case of a patient who ingested a dose of 17.5 g venlafaxine. She developed a full serotonergic syndrome leading to multi-organ failure, including refractory cardiovascular shock, which was managed by early implantation of an extracorporeal life support (ECLS) system as a bridging strategy. This intervention was successful and resulted in full recovery of the patient.

Successfully treated necrotizing fasciitis using extracorporeal life support combined with hemoadsorption device and continuous renal replacement therapy

2018 ◽  
Vol 41 (3) ◽  
pp. 178-182 ◽  
Author(s):  
Maroua Eid ◽  
Olivier Fouquet ◽  
Cédric Darreau ◽  
Marc Pierrot ◽  
Achille Kouatchet ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Necrotizing Fasciitis ◽  
Replacement Therapy ◽  
Organ Failure ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Blood Parameters ◽  
Multiple Organ ◽  
Superficial Fascia

Introduction: Necrotizing fasciitis represents a life-threatening infectious condition that causes spreading necrotisis of superficial fascia and subcutaneous cellular tissues. We describe the case of a patient diagnosed with septic and toxic shocks leading to multiple organ failure successfully treated with a combination of extracorporeal life support, continuous renal replacement therapy, and a hemoadsorption device. Methods: A 41-year-old patient presented with necrotizing fasciitis and multi-organ failure. Initial extracorporeal life support therapy was implanted, compensating for systolic failure. Due to acute renal failure that persisted in time, continuous renal replacement therapy was added. Despite these treatments and as a last attempt to control the septic condition, a CytoSorb® hemoadsorption device was installed in parallel to the extracorporeal life support circuit and two sessions were run. Results: During the days following CytoSorb® treatment, hemodynamic stabilization was observed, as well as normalization of lactic acidosis and blood parameters. Conclusion: This case describes the successful use of CytoSorb® with continuous renal replacement therapy and extracorporeal life support in a combined way to overcome a critical phase of septic shock in a young adult patient. This combination of treatments turned out to be efficient for this patient in the context of necrotizing fasciitis.

Multiple Organ Failure and Refractory Cardiogenic Shock due to Venlafaxine Intoxication, Successfully Treated with Veno-Arterial Extracorporeal Life Support

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Painvin B ◽  
◽  
Le Balc’h P ◽  
Gicquel T ◽  
Camus C ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Multiple Organ ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prolonged Release ◽  
Refractory Cardiogenic Shock

Venlafaxine has critical side effects from arrhythmias to cardiogenic shock after toxic dose ingestion. We report a case of venlafaxine intoxication with Multiple Organ Failure (MOF) treated with Veno-Arterial Extracorporeal Life Support (VA-ECLS). A 60-year old male with a history of chronic depression ingested 72 tablets of prolonged-release venlafaxine hydrochloride 75 mg (total 5400 mg). Initial EKG showed broadened QRS complexes and Transthoracic Echocardiography (TTE) revealed diffuse ventricular hypokinesia with Left Ventricular Ejection Fraction (LVEF) of 15% for which dobutamine infusion was started. Due to persistent refractory cardiogenic shock and MOF, a Medos® Deltastream® VA-ECLS was surgically implanted in our intensive care unit. On day 1, toxicology analysis found plasma concentrations of venlafaxine 3.2mg/L and its metabolite desmethylvenlafaxine at 0.92 mg/L. At day 6, we performed a weaning trial, enabling ECLS removal. Motion defect of anteroseptal and inferolateral walls was also noticed. EKGs showed a shorten R wave in the anteroseptal territory leading to the potential diagnosis of underlying ischemic cardiomyopathy. The patient was extubated at day-10 and discharged for cardiology unit at day-17. At day-20, cardiac magnetic resonance imaging showed no sign of ischemia and TTE parameters were normalized. This is the first report of refractory cardiogenic shock and MOF due to venlafaxine intoxication treated with VA-ECLS. The main objective of ECLS is to restore cardiac output especially when ventricular failure is refractory to inotropes. Our experience suggests that MOF secondary to refractory cardiogenic shock should quickly prompt the implantation of a VA-ECLS in venlafaxine critical overdose.

scholarly journals Use of Extracorporeal Life Support for Heart Transplantation: Key Factors to Improve Outcome

2021 ◽  
Vol 10 (12) ◽  
pp. 2542
Author(s):  
Jun Ho Lee ◽  
Nayeon Choi ◽  
Yun Jin Kim ◽  
Kiick Sung ◽  
Wook Sung Kim ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Organ Failure ◽  
Primary Outcome ◽  
Life Support ◽  
Total Bilirubin ◽  
Extracorporeal Life Support ◽  
Total Bilirubin Level ◽  
Key Factors ◽  
Bridge To Transplantation ◽  
Failure Assessment

Although patients receiving extracorporeal life support (ECLS) as a bridge to transplantation have demonstrated worse outcomes than those without ECLS, we investigated the key factors in the improvement of their posttransplant outcome. From December 2003 to December 2018, 257 adult patients who underwent heart transplantation (HTx) at our institution were included. We identified 100 patients (38.9%) who underwent HTx during ECLS (ECLS group). The primary outcome was 30-day mortality after HTx. The median duration of ECLS was 10.0 days. The 30-day mortality rate was 3.9% (9.2% in peripheral ECLS, 2.9% in central ECLS, and 1.9% in non-ECLS). The use of ECLS was not an independent predictor of 30-day and 1-year mortality (p = 0.248 and p = 0.882, respectively). Independent predictors of 30-day mortality were found to be higher ejection fraction (p < 0.001), Sequential Organ Failure Assessment score (p < 0.001), and total bilirubin level (p = 0.005). In a subgroup analysis, cannulation type was not a predictor of 30-day mortality (p = 0.275). Early ECLS application to prevent organ failure and sophisticated management of acute heart failure may be important steps in achieving favorable survival after HTx.

scholarly journals Rationale of Hemoadsorption during Extracorporeal Membrane Oxygenation Support

2019 ◽  
Vol 48 (3) ◽  
pp. 203-214 ◽  
Author(s):  
L. Christian Napp ◽  
Stephan Ziegeler ◽  
Detlef Kindgen-Milles
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Organ Failure ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Underlying Disease ◽  
Ecmo Support ◽  
Membrane Oxygenation ◽  
Lung Failure ◽  
Molecular Patterns ◽  
Inflammatory Molecules

Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support are increasingly used for treating various forms of shock, lung failure, protected interventions and life support including resuscitation. Most patients on ECMO are affected by a systemic inflammatory response caused by the underlying disease as well as the ECMO support itself, which contributes to vasoplegia, multi-organ failure, deterioration and death. Unfortunately, effective strategies for control of inflammation and related organ failure and shock on ECMO are lacking. Recently, a new polystyrene-based device for hemoadsorption, which aims to reduce excessive levels of inflammatory molecules such as interleukins, cytokines as well as damage- and pathogen-associated molecular patterns, has become available. Here we summarize the rationale, available data and technical aspects of polystyrene-based hemoadsorption during ECMO support, and give recommendations based on existing experience.

scholarly journals Leptospirosis with pulmonary haemorrhage and multiple organ failure: a case report and literature review

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110196
Author(s):  
Wei-Hua Dong ◽  
Zhi Chen
Keyword(s):  
Multiple Organ Failure ◽  
Organ Failure ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Lavage Fluid ◽  
Haemorrhagic Shock ◽  
Multiple Organ ◽  
Pulmonary Haemorrhage ◽  
Life Threatening ◽  
History Of

Pulmonary haemorrhage is an important complication of leptospirosis. We herein report an uncommon case of severe pulmonary haemorrhage and multiple organ failure caused by leptospirosis in a 49-year-old man who was previously healthy. He was a farm worker who was admitted to the hospital because of haemoptysis. He had worked in a paddy field 4 days prior to admission. Chest computed tomography revealed pulmonary haemorrhage, which rapidly deteriorated into haemorrhagic shock and multiple organ failure. Based on the patient’s possible history of contact with contaminated water and the DNA sequence of Leptospira detected in his bronchoalveolar lavage fluid, the patient was diagnosed with pulmonary haemorrhagic leptospirosis. Despite the administration of a fluid bolus, norepinephrine, broad-spectrum antibiotics, and haemostatics, and even with administration of a blood transfusion and extracorporeal life support, the pulmonary haemorrhage could not be controlled effectively. The patient eventually died of haemorrhagic shock. Leptospirosis can be a life-threatening disease despite aggressive treatment, even with extracorporeal life support. Next-generation sequencing can provide important diagnostic clues for patients with atypical leptospirotic symptoms.

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