1173

Abstract

Crit Care Med 2014 • Volume 42 • 12 (Suppl.) oxygenation and ventilation, using DLT and a bronchial blocker provides isolation of the diseased lung, while using the rest to maintain adequate gas exchange. This method can be useful in managing patients with respiratory failure and pneumothorax where less invasive methods are insufficient.Learning Objectives: Ibogaine is a naturally occurring alkaloid with hallucinogenic and psychedelic effects. It is classified as a schedule I controlled substance in the U.S., but is available in several countries and may also be purchased through the internet. It is promoted as an antiaddiction medication, but safety concerns include the risk of cardiac arrhythmias; the mechanism of which is unclear but may involve inhibition of hERG potassium or sodium channels. This case involved a 40 year old female with a history of cocaine and heroin abuse taking ibogaine to help decrease drug cravings. EMS was called when the patient was found unresponsive at home. Naloxone 1 mg was administered en route resulting in slight arousal and agitation. Upon arrival to the emergency department, the patient had continued agitation and received lorazepam 2 mg IV and haloperidol 5 mg IV. Shortly after, the patient became bradycardic and developed an episode of nonsustained ventricular tachycardia (VT) which selfresolved. A brief generalized tonic-clonic seizure ensued and the patient was subsequently intubated. Multifocal premature ventricular contractions (PVCs) were observed on telemetry and the patient was given 2 g of IV magnesium sulfate with resolution of PVCs. EKG results revealed a prolonged QTc interval of 599 msec and initial labs had notable derangements of serum magnesium (1.1 mg/ dL) and potassium (3.4 mEq/L). 10 hours after admission, the patient went into cardiac arrest due to polymorphic VT consistent with torsade de pointes. Chest compressions were performed with ROSC with sinus rhythm. An EKG revealed a prolonged QTc interval of 601 msec and 2 g of IV magnesium sulfate was administered. Over the 6-day admission, the patient's QTc trended downward with no further cardiac issues. The etiology of torsade de pointes is attributed to ibogaine use, concomitant haloperidol administration, and electrolyte abnormalities. This case correlates long-QT syndrome and torsade de pointes with the use of ibogaine, a compound being actively evaluated for its potential to treat substance addiction.