Successful usage of intravenous lipid emulsion in treatment of acute verapamil poisoning: A case report

Abstract

Introduction. During the last few years, intravenous lipid emulsions have been effectively used in treatment of acute poisonings with lipophilic substances, including verapamil. Case report. A 37-year-old women presented 1 hour after ingestion of 2.8 g verapamil with hypotension and complete heart block. Because of the applied standard therapy failure and further patients impairment, Intralipid ® 20% was used. Sinus rhythm was restored, arterial blood pressure increased and verapamile concentrations, both total and free decreased. Conclusion. Intravenous lipid emulsion can be important in treatment of severe acute intoxication and cardiotoxicity caused by verapamil.Uvod. Poslednjih godina intravenske emulzije masti uspešno se koriste u terapiji akutnih trovanja lipofilnim supstancama, uključujući i verapamil. Prikaz bolesnika. Prikazana je 37godišnja pacijentkinja primljena jedan sat nakon ingestije 2,8 g verapamila. Na prijemu je bila hipotenzivna, sa kompletnim srčanim blokom. Zbog izostanka efekta primenjene standardne terapije i daljeg pogoršanja stanja pacijentkinje primenjen je Intralipid ® 20%, nakon čega je uspostavljen sinusni ritam. Zabeležen je porast arterijskog pritiska, uz smanjenje koncentracije verapamila, kako ukupnog, tako i slobodne frakcije leka. Zaključak. Intravenske emulzije masti mogu zauzeti važno mesto u terapiji teške akutne intoksikacije i kardiotoksičnosti uzrokovane verapamilom.

Dosage of Lipid Emulsions as an Antidote to Lipid-Soluble Substances

“…In most of the described clinical cases in the available literature, LE has been administered according to the ASRA regimen. [10][11][12][13][14][15][16][17][18][19] In the present study, the increased use of low-dose LE was explained by the careful approach to the new drug and possible side effects of LE, as well as by the fact that most patients with acute intoxication treated with low dose of LE were hemodynamically stable.…”

Extracorporeal life support for severe cardiogenic shock induced by diltiazem intoxication

“…Specific measures suggested for a treatment of CCB poisoning include administration of high dose of insulin, calcium, dopamine, noradrenaline or LET [7][8][9][10] . As demonstrated in our case, most of the recommended therapeutic options were performed with no satisfactory result, prompting another approach -extracorporeal life support.…”