Acute Respiratory Distress Syndrome Associated with Intravenous Lipid Emulsion Therapy for Verapamil Toxicity, Successfully Treated with Veno-Venous ECMO

Abstract

Calcium channel blocker (CCB) overdose is a potentially fatal poisoning. The use of intravenous lipid emulsion (ILE) therapy for CCB poisoning has emerged in the past few years. In 2017, the American College of Medical Toxicology published interim guidance for the use of ILE resuscitation in these cases. We report an uncommon complication of ILE, acute respiratory distress syndrome, treated with veno-venous extracorporeal membrane oxygenation (ECMO).Case report: A 40-year-old hypertensive woman presented with shock (blood pressure 62/34 mmHg, pulse 86/ min) following ingestion of 4,800 mg verapamil slow release and 1,500 mcg clonidine during a suicide attempt. She was treated with calcium gluconate, sodium bicarbonate, IV high dose insulin, IV glucagon, cardiac amines and vasopressors without response (blood pressure 69/37 mmHg, pulse 78/min). ILE was initiated, and two hours later, she developed acute respiratory failure necessitating intubation and mechanical ventilation. Due to poor oxygenation (pO 2 44 mmHg; FiO 2 100%) emergent veno-venous ECMO was instituted. After one hour her blood pressure increased to 104/50 mmHg (pulse 80, pO 2 75 mmHg), and continued so until weaning from ECMO and ventilation. Conclusion:Acute respiratory distress syndrome can be a major life threating complication following ILE; venovenous ECMO is suggested for its treatment.

Suspected Acute Respiratory Distress Syndrome Associated With the Use of Intravenous Lipid Emulsion Therapy in a Dog: A Case Report

“…There are reports implicating ARDS as a potential adverse event associated with ILE infusions in people, however most of the patients were critically ill, making it hard to discern whether ARDS resulted from ILE infusion or was a result of underlying illness (12, 27, 30). The authors do not believe that this patient had an additional condition predisposing to the development of ARDS, though this cannot be entirely ruled out.…”

“…Reported adverse events associated with ILE infusions are sporadic or extrapolated from its use in parenteral nutrition, there is a case report of suspected acute respiratory distress syndrome (ARDS) secondary to the use of ILE for verapamil toxicosis (12). The adverse events reported with ILE infusions include phlebitis, immunosuppression, cardiovascular, lipid-emboli, hemolysis, acute kidney injury, metabolic acidosis, pulmonary complications (acute lung injury, ARDS, hypoxia and ventilation-perfusion mismatch), pancreatitis or fat overload syndrome, hypersensitivity or allergic reactions and vomiting, persistent gross lipemia and suspected corneal lipidosis (2, 7, 9–11, 13–19).…”

Influence of l-type slow calcium channels blockers on cardiac, respiratory and motor activity at the intact and poisoned by physostigmine (eserine) of rats during the early ontogeny

“…Показано, что передозировка верапамила сопровождается гипотензией, брадиаритмией, блоками атриовентрикулярной проводимости и остановкой сердца [10,11].…”