Toxin-Induced Cardiovascular Failure

Jang, David H.; Spyres, Meghan B.; Fox, Lindsay; Manini, Alex F.

doi:10.1016/j.emc.2013.10.003

Cited by 29 publications

(10 citation statements)

References 83 publications

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“…Clinical predictors of drug overdose-related mortality depend on a variety of factors related to each individual exposure; however, a final common pathway of in-hospital drug-induced cardiac arrest likely involves myocardial toxicity [4], as respiratory arrests are readily preventable in the hospital setting. Drug toxicity may cause myocardial injury through a variety of mechanisms, including but not limited to, myocardial oxygen supply/demand mismatch (e.g., coronary artery vasospasm) [5], ion-channel poisoning (e.g., digoxin) [6], as well as direct myocardial toxicity (i.e., through inhibition of intrinsic metabolic pathways such as oxidative phosphorylation) [7].…”

Section: Introductionmentioning

confidence: 99%

Utility of Cardiac Troponin to Predict Drug Overdose Mortality

et al. 2015

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Drug overdose is now the leading cause of injury-related mortality in the USA, but the prognostic utility of cardiac biomarkers is unknown. We investigated whether serum cardiac troponin I (cTnI) was associated with overdose mortality. This prospective observational cohort studied adults with suspected acute drug overdose at two university hospital emergency departments (ED) over 3 years. The endpoint was in-hospital mortality, which was used to determine test characteristics of initial/peak cTnI. There were 437 overdoses analyzed, of whom there were 20 (4.6 %) deaths. Mean initial cTnI was significantly associated with mortality (1.2 vs. 0.06 ng/mL, p <0.001), and the ROC curve revealed excellent cTnI prediction of mortality (AUC 0.87, CI 0.76–0.98). Test characteristics for initial cTnI (90 % specificity, 99 % negative predictive value) were better than peak cTnI (88.2 % specificity, 99.2 % negative predictive value), and initial cTnI was normal in only one death out of the entire cohort (1/437, CI 0.1–1.4 %). Initial cTnI results were highly associated with drug overdose mortality. Future research should focus on high-risk overdose features to optimize strategies for utilization of cTnI as part of the routine ED evaluation for acute drug overdose.

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Section: Introductionmentioning

confidence: 99%

Utility of Cardiac Troponin to Predict Drug Overdose Mortality

et al. 2015

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“…Based on current knowledge, insulin and glucose infusion should be used in shock caused by calcium channel antagonists and β-adrenergic blocking agents that is unresponsive to fluid resuscitation [123] (Level III recommendation). While glucagon can be considered in shock from β-adrenergic blocking agents in the author's opinion, many practicing medical toxicologists prefer HIE or vasopressors, instead.…”

Section: Vasoactive Agentsmentioning

confidence: 99%

Therapeutic Approach to the Critically Poisoned Patient

Schwarz¹

2016

Critical Care Toxicology

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“…IVLE treatment is included in the treatment algorithms of beta blocker poisoning [5] . Previous studies have shown the beneficial effects of IVLE administration on propranolol, atenolol and nebivolol toxicities [19][20][21][22][23][24][25][26][27][28][29] . The common point of these events and experimental studies is the reversal of cardiovascular changes resulting from intoxication with highly lipid soluble drugs thanks to intravenous lipid administration.…”

Section: The Efficacy Of Intravenous Lipid Emulsion Therapy (Ivle)mentioning

confidence: 99%

Intravenous lipid emulsion therapy in a case of multiple drug intoxication (case report)

Hancı¹

2018

Haydarpasa Numune Med J

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I n the United States every day approximately 2000 cases of intoxication apply to emergency services. Drug intoxication is the most important cause of mortality in adults aged 35-54 years [1]. Cardiovascular drugs are frequently used to commit suicide, and they are at the top of the list of deaths due to poisoning [2]. Standard resuscitation algorithms are often inadequate in intoxications and it is important to consider adjuvant treatments with appropriate antidotes for intoxicated patients. Current treatment algorithms often priorly suggest supportive and symptomatic treatments in the absence of specific therapeutic interventions. Specific antidotes are not available in the majority of intoxications [3]. Metoprolol is a selective β1 adrenergic antagonist. It is the only β1 adrenergic antagonist with official approval by the FDA (Food and Drug Administration) for the treatment of angina pectoris and complications after acute myocardial infarction. It may be used to control ventricular rate, to prevent tachycardia and hypertension in supraventricular tachycardias, atrial fibrillation or flutter occurring in response to perioperative stimuli. When used through IV route, its effect starts within 5-10 minutes and lasts for 2-4 hours [4]. Intake of cardiovascular drugs is frequently observed among the patients brought to emergency departments with an intoxication clinic. In those patients who are treated for intoxication, actual therapy is mainly supportive in most of the cases if there isn't any special antidote for the agent. This case report is about a patient who intended to commit suicide with oral intake of metoprolol, perindopril, atorvastati and isosorbide monohydrate. Upon worsening of her general condition in spite of supportive therapy, she was given intravenous lipid therapy. In this manuscript, application of intravenous lipid therapy is presented in a patient who intended to commit suicide, She was unresponsive to supportive therapy after ingestion of multiple cardiovascular drugs including metoprolol, perindopril, isosorbide monohydrate and atorvastatin.

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Toxin-Induced Cardiovascular Failure

Cited by 29 publications

References 83 publications

Utility of Cardiac Troponin to Predict Drug Overdose Mortality

Utility of Cardiac Troponin to Predict Drug Overdose Mortality

Therapeutic Approach to the Critically Poisoned Patient

Intravenous lipid emulsion therapy in a case of multiple drug intoxication (case report)

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