Cardiac arrest due to a fatal dose of propranolol successfully treated with intravenous lipid infusion

Kendirli, Tanıl; Gün, Emrah; Balsak, Serdar; Ramoğlu, Mehmet Gökhan; Tutar, Ercan

doi:10.24953/turkjped.2021.05.020

Cited by 4 publications

(1 citation statement)

References 8 publications

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“…Cardiac arrest is a serious condition resulting from severe coronary artery disease [ 1 ], heart failure [ 2 , 3 ], hemorrhagic shock [ 4 , 5 ], asphyxia [ 6 ], overdose of drugs [ 7 , 8 ], and abnormal potassium [ 9 ]. During cardiac arrest, organs are subjected to severe ischemic insult due to an abrupt loss of the heart’s ability to pump [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Manganese Porphyrin Promotes Post Cardiac Arrest Recovery in Mice and Rats

Wang

Liu

Yan

et al. 2022

Biology

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Introduction Cardiac arrest (CA) and resuscitation induces global cerebral ischemia and reperfusion, causing neurologic deficits or death. Manganese porphyrins, superoxide dismutase mimics, are reportedly able to effectively reduce ischemic injury in brain, kidney, and other tissues. This study evaluates the efficacy of a third generation lipophilic Mn porphyrin, MnTnBuOE-2-PyP5+, Mn(III) ortho meso-tetrakis (N-n-butoxyethylpyridinium-2-yl)porphyrin (MnBuOE, BMX-001), in both mouse and rat models of CA. Methods Forty-eight animals were subjected to 8 min of CA and resuscitated subsequently by chest compression and epinephrine infusion. Vehicle or MnBuOE was given immediately after resuscitation followed by daily subcutaneous injections. Body weight, spontaneous activity, neurologic deficits, rotarod performance, and neuronal death were assessed. Kidney tubular injury was assessed in CA mice. Data were collected by the investigators who were blinded to the treatment groups. Results Vehicle mice had a mortality of 20%, which was reduced by 50% by MnBuOE. All CA mice had body weight loss, spontaneous activity decline, neurologic deficits, and decreased rotarod performance that were significantly improved at three days post MnBuOE daily treatment. MnBuOE treatment reduced cortical neuronal death and kidney tubular injury in mice (p < 0.05) but not hippocampus neuronal death (23% MnBuOE vs. 34% vehicle group, p = 0.49). In rats, they had a better body-weight recovery and increased rotarod latency after MnBuOE treatment when compared to vehicle group (p < 0.01 vs. vehicle). MnBuOE-treated rats had a low percentage of hippocampus neuronal death (39% MnBuOE vs. 49% vehicle group, p = 0.21) and less tubular injury (p < 0.05) relative to vehicle group. Conclusions We demonstrated the ability of MnBuOE to improve post-CA survival, as well as functional outcomes in both mice and rats, which jointly account for the improvement not only of brain function but also of the overall wellbeing of the animals. While MnBuOE bears therapeutic potential for treating CA patients, the females and the animals with comorbidities must be further evaluated before advancing toward clinical trials.

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Section: Introductionmentioning

confidence: 99%

Manganese Porphyrin Promotes Post Cardiac Arrest Recovery in Mice and Rats

Wang

Liu

Yan

et al. 2022

Biology

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Multiple drugs

2021

Reactions Weekly

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Multiple drugsVarious toxicities following overdose and lack of response: case report A 2-year-old girl developed cardiac arrest, bradycardia, ventricular tachycardia, decompensated shock and hypotension due to propranolol poisoning following propranolol overdose. Additionally, she exhibited lack of response while receiving epinephrine, norepinephrine, dopamine, insulin and calcium gluconate for the hypotension and decompensated shock.The girl was admitted with vomiting and drowsiness, which were started 6 hours ago. On admission, her Glasgow Coma Scale (GCS) was 6 and she developed cardiac arrest. Cardiopulmonary resuscitation (CPR) was initiated.The girl received one dose of epinephrine after endotracheal intubation. In 5 minutes she had return of spontaneous circulation (ROSC). After ROSC, her cebtral pulses were weak and peripheral pulses were absent. She received sodium-chloride [saline] infusion. Her blood glucose level was 96 mg/dL. She was transferred to an paediatric intensive care unit (PICU). She was connected to a mechanical ventilator and a central venous catheter was inserted. She received serum IV fluid therapy with sodium-chloride infusion. Epinephrine 0.1 µ/kg/min infusion was also initiated. Her venous blood gases test findings were as follows; pH: 7.10, pCO2: 45, pO2: 20.9 HCO3: 13.5, lactate: 5.2 mmol/L. Biochemical parameters and other blood values were normal. Fifteen minutes after the PICU admission, she again developed cardiac arrest. CPR again initiated. She received epinephrine [adrenaline] 7 times and one dose of bicarbonate. Her bradycardia was continued and atropine was administered. In 20 minutes, she had ROSC and her rhythm was pulsed ventricular tachycardia. She underwent electrical cardioversion and she started receiving amiodarone. Electrocardiography revealed her QTc> 0.55s. Therefore, amiodarone was discontinued. She required a high dose inotropic support. She received epinephrine 0.3 µg/kg/min, norepinephrine 0.1 µg/kg/min and dopamine 10 µg/kg/min. Her history revealed that she had ingested 5 tablets of her grandmother's drug, propranolol 40mg equivalent to 17 mg/kg [Dideral]. She was suspected with propranolol poisoning. She received activated charcoal. Despite the treatment with high dose inotropes and vasopressors, she was hypotensive (53/35 mmHg). Therefore, IV bolus of insulin 1 U/kg was initiated. Later, switched to insulin 0.5 U/kg/hr infusion. She also received calcium gluconate 10% infusion at a dose of 1 mL/kg and subcutaneous glucagon. However, no response was noted and she continued to have decompensated shock. She started receiving IV lipid infusion at minute 60 of the PICU admission. She had an improvement within hours. Consequently, the epinephrine and norepinephrine doses were decreased. Her blood gases findings and biochemical values were improved. At hour 24 of the admission, laboratory and electrocardiogram findings were returned to normal. She was extubated and at the end of the hour 24 all therapies were discontinued. On day 03, she was discharged with fu...

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Antihypertensive drugs

Choi

Hall²

2022

Side Effects of Drugs Annual

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Cardiac arrest due to a fatal dose of propranolol successfully treated with intravenous lipid infusion

Cited by 4 publications

References 8 publications

Manganese Porphyrin Promotes Post Cardiac Arrest Recovery in Mice and Rats

Manganese Porphyrin Promotes Post Cardiac Arrest Recovery in Mice and Rats

Multiple drugs

Antihypertensive drugs

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