Sažetak
Uvod. Poslednjih godina intravenske emulzije masti uspešno se koriste u terapiji akutnih trovanja lipofilnim supstancama, uključujući i verapamil. Prikaz bolesnika. Prikazana je 37-godišnja pacijentkinja primljena jedan sat nakon ingestije 2,8 g verapamila. Na prijemu je bila hipotenzivna, sa kompletnim srčanim blokom. Zbog izostanka efekta primenjene standardne terapije i daljeg pogoršanja stanja pacijentkinje primenjen je Intralipid® 20%, nakon čega je uspostavljen sinusni ritam. Zabeležen je porast arterijskog pritiska, uz smanjenje koncentracije verapamila, kako ukupnog, tako i slobodne frakcije leka. Zaključak. Intravenske emulzije masti mogu zauzeti važno mesto u terapiji teške akutne intoksikacije i kardiotoksičnosti uzrokovane verapamilom.
Ključne reči
||trovanje
suicide||
||samoubistvo
verapamil||
||verapamil
calcium channel blockers||
||kalcijum
blokatori
heart block||
||srce
blok
fat emulsions
intravenous||
||masne emulzije
intravenske
treatment outcome||
||lečenje
ishod
Reference
Mégarbane B, Karyo S, Abidi K, Delhotal-Landes B, Aout M, Sauder P, et al. Predictors of mortality in verapamil overdose: useful-ness of serum verapamil concentrations. Basic Clin Pharmacol Toxicol 2011; 108(6): 385−9.
St-Onge M, Dubé PA, Gosselin S, Guimont C, Godwin J, Archambault PM, et al. Treatment for calcium channel blocker poisoning: a systematic review. Clin Toxicol (Phila) 2014; 52(9): 926−44.
Jamaty C, Bailey B, Larocque A, Notebaert E, Sanogo K, Chauny J. Lipid emulsions in the treatment of acute poisoning: a system-atic review of human and animal studies. Clin Toxicol (Phila) 2010; 48(1): 1−27.
Moffat A, Osselton MD, Widdop B. Clarke's Analysis of Drugs and Poisons. 3rd ed. London: Pharmaceutical Pres; 2004.
Putić V, Jović-Stošić J. Intravenous fat emulsion in clinical prac-tice: nutrient and antidote. Vojnosanit Pregl 2015; 72(3): 274−9.
Weinberg GL. Lipid emulsion infusion: Resuscitation for local anesthetic and other drug overdose. Anesthesiology 2012; 117(1): 180−7.
Safety guideline, Management of severelocal anaesthetic toxici-ty. Association of Anaesthetists of Great Britain and Ireland. 2010. Available from: http://www.aagbi.org/sites/default/files/la_toxicity_2010_0.pdf
Cave G, Harvey MG. Should we consider the infusion of lipid emulsion in the resuscitation of poisoned patients. Crit Care 2014; 18(5): 457.
Tebbutt S, Harvey M, Nicholson T, Cave G. Intralipid prolongs survival in a rat model of verapamil toxicity. Acad Emerg Med 2006; 13(2): 134−9.
Bania TC, Chu J, Perez E, Su M, Hahn I. Hemodynamic effects of intravenous fat emulsion in an animal model of severe ve-rapamil toxicity resuscitated with atropine, calcium, and saline. Acad Emerg Med 2007; 14(2): 105−11.
Young AC, Velez LI, Kleinschmidt KC. Intravenous fat emulsion therapy for intentional sustained-release verapamil overdose. Resuscitation 2009; 80(5): 591−3.
French D, Armenian P, Ruan W, Wong A, Drasner K, Olson KR, et al. Serum verapamil concentrations before and after In-tralipid® therapy during treatment of an overdose. Clin Toxi-col (Phila) 2011; 49(4): 340−4.
Assink MA, Spronk PE, van Kan HJ, Braber A. Intravenous lipid emulsion in the treatment of verapamil intoxication. Neth J Crit Care 2013; 17(3): 18−21.
French D, Smollin C, Ruan W, Wong A, Drasner K, Wu AH. Parti-tion constant and volume of distribution as predictors of clini-cal efficacy of lipid rescue for toxicological emergencies. Clin Toxicol (Phila) 2011; 49(9): 801−9.
Jović-Stošić Ј, Putić V, Živanović D, Mladenov M, Brajković G, Djordjević S. Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydro-pyridine calcium channel blockers. Vojnosanit Pregl 2015; Online First March (00): 18–18. DOI: 10.2298/VSP141216018J