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

Abstract

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.