Extracorporeal Albumin Dialysis in Three Cases of Acute Calcium Channel Blocker Poisoning With Life-Threatening Refractory Cardiogenic Shock

Pichon, Nicolas; Dugard, Anthony; Clavel, M.; Amiel, Jeanne; Dalmay, François; Vignon, Philippe

doi:10.1016/j.annemergmed.2011.07.029

Cited by 35 publications

(25 citation statements)

References 17 publications

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“… 124 , 125 One human case series 126 and two case reports 127 , 128 suggested use of plasma exchange to decrease verapamil concentrations and improve hemodynamics. One human case series of three patients 129 and one case report 130 suggested the use of extracorporeal albumin dialysis to improve hemodynamics without a clear impact on the serum CCB concentrations. Only human case reports were found for charcoal hemoperfusion; 131 continuous venovenous hemodiafiltration; 132–135 insertion of an intra-aortic balloon pump, 136 Impella device, 137 and methylene blue.…”

Section: Resultsmentioning

confidence: 99%

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Treatment for calcium channel blocker poisoning: A systematic review

St‐Onge

Dubé

Gosselin

et al. 2014

Clinical Toxicology

155

135

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ContextCalcium channel blocker poisoning is a common and sometimes life-threatening ingestion.ObjectiveTo evaluate the reported effects of treatments for calcium channel blocker poisoning. The primary outcomes of interest were mortality and hemodynamic parameters. The secondary outcomes included length of stay in hospital, length of stay in intensive care unit, duration of vasopressor use, functional outcomes, and serum calcium channel blocker concentrations.MethodsMedline/Ovid, PubMed, EMBASE, Cochrane Library, TOXLINE, International pharmaceutical abstracts, Google Scholar, and the gray literature up to December 31, 2013 were searched without time restriction to identify all types of studies that examined effects of various treatments for calcium channel blocker poisoning for the outcomes of interest. The search strategy included the following Keywords: [calcium channel blockers OR calcium channel antagonist OR calcium channel blocking agent OR (amlodipine or bencyclane or bepridil or cinnarizine or felodipine or fendiline or flunarizine or gallopamil or isradipine or lidoflazine or mibefradil or nicardipine or nifedipine or nimodipine or nisoldipine or nitrendipine or prenylamine or verapamil or diltiazem)] AND [overdose OR medication errors OR poisoning OR intoxication OR toxicity OR adverse effect]. Two reviewers independently selected studies and a group of reviewers abstracted all relevant data using a pilot-tested form. A second group analyzed the risk of bias and overall quality using the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist and the Thomas tool for observational studies, the Institute of Health Economics tool for Quality of Case Series, the ARRIVE (Animal Research: Reporting In Vivo Experiments) guidelines, and the modified NRCNA (National Research Council for the National Academies) list for animal studies. Qualitative synthesis was used to summarize the evidence. Of 15,577 citations identified in the initial search, 216 were selected for analysis, including 117 case reports. The kappa on the quality analysis tools was greater than 0.80 for all study types.ResultsThe only observational study in humans examined high-dose insulin and extracorporeal life support. The risk of bias across studies was high for all interventions and moderate to high for extracorporeal life support. High-dose insulin. High-dose insulin (bolus of 1 unit/kg followed by an infusion of 0.5–2.0 units/kg/h) was associated with improved hemodynamic parameters and lower mortality, at the risks of hypoglycemia and hypokalemia (low quality of evidence). Extracorporeal life support. Extracorporeal life support was associated with improved survival in patients with severe shock or cardiac arrest at the cost of limb ischemia, thrombosis, and bleeding (low quality of evidence). Calcium, dopamine, and norepinephrine. These agents improved hemodynamic parameters and survival without documented severe side effects (very low quality of evidence). 4-Aminopyridine. Use of 4-aminopyridine was assoc...

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Section: Resultsmentioning

confidence: 99%

“…93–94 Extracorporeal life support 22 for patients with cardiac arrest or severe shock refractory to conventional therapy reported a benefit in survival. Two patients survived with albumin dialysis, 129 , 130 and only animal studies supported the use of Bay K8644. 100 , 101 , 103…”

Section: Resultsmentioning

confidence: 99%

Treatment for calcium channel blocker poisoning: A systematic review

St‐Onge

Dubé

Gosselin

et al. 2014

Clinical Toxicology

155

135

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“…There are also more specific treatment modalities for poisonings with cardiovascular agents (e.g., Fab-antidotal therapy for digitalis poisoning; enhanced elimination procedures, including single-pass albumin dialysis, the molecular adsorbents recirculating system (MARS™) technique, or plasma exchange therapy), which are discussed separately within the respective chapters of this textbook. Although the latter extracorporeal elimination techniques may have a role in very special settings of highly protein-bound drug-overdoses (where conventional hemodialysis fails) [46,47], it is needless to say that most of these techniques require a minimum degree of hemodynamic stability (i.e., sufficiently high CO) to be applicablea prerequisite that essentially limits their use in patients with poison-induced severe hypotension, shock, or even cardiac arrest.…”

Section: Antidotal Therapymentioning

confidence: 99%

Hypotension and Shock in the Poisoned Patient

Eyer¹

2016

Critical Care Toxicology

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Agents that may lead to bradycardia Agents that may lead to tachycardia Beta-receptor blockers Sodium channel blockers such as tricyclic antidepressants, type 1 antiarrhythmics, local anesthetics, chloroquine, quinine Calcium channel blockers Other pharmaceuticals (e.g., theophylline) Alpha 2-receptor agonists (e.g., clonidine, dexmedetomidine) Drugs of abuse (e.g., amphetamines, cocaine) Cardioactive glycosides (e.g., digoxin, fox glow, yellow oleander) Cardioactive glycosides (e.g., digoxin, fox glow, yellow oleander) Cholinergic agents (e.g., organophosphate compounds, carbamates) Natural toxins (e.g., aconitine, night-shadow plants) Potassium channel blockers (type III antiarrhythmics) (e.g., sotalol, amiodarone) Potassium channel blockers (type III antiarrhythmics) (e.g., sotalol, amiodarone) Noradrenaline reuptake inhibitors (e.g., venlafaxine)

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“…The principle for their use is that by adding albumin to the dialysate, a protein‐binding disequilibrium is created where unbound drug from the blood side could bind to the albumin on the dialysate side. These techniques have been used for treatments of poisoning with varying degrees of success . Although experimental studies show clearances of endogenous molecules varying from 10 to 75 ml/minute for both MARS and Prometheus , the clearance of several drugs rarely exceeds 40 ml/minute, even at a high Q B , which is lower than what can be attainable with other ECTRs.…”

Section: Albumin Dialysismentioning

confidence: 99%

Available Extracorporeal Treatments for Poisoning: Overview and Limitations

Ouellet

Bouchard

Ghannoum

et al. 2014

Seminars in Dialysis

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Poisoning is a significant public health problem. In severe cases, extracorporeal treatments (ECTRs) may be required to prevent or reverse major toxicity. Available ECTRs include intermittent hemodialysis, sustained low-efficiency dialysis, intermittent hemofiltration and hemodiafiltration, continuous renal replacement therapy, hemoperfusion, therapeutic plasma exchange, exchange transfusion, peritoneal dialysis, albumin dialysis, cerebrospinal fluid exchange, and extracorporeal life support. The aim of this article was to provide an overview of the technical aspects, as well as the potential indications and limitations of the different ECTRs used for poisoned patients.

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Extracorporeal Albumin Dialysis in Three Cases of Acute Calcium Channel Blocker Poisoning With Life-Threatening Refractory Cardiogenic Shock

Cited by 35 publications

References 17 publications

Treatment for calcium channel blocker poisoning: A systematic review

Treatment for calcium channel blocker poisoning: A systematic review

Hypotension and Shock in the Poisoned Patient

Available Extracorporeal Treatments for Poisoning: Overview and Limitations

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