Asystole shortly after intravenous fat emulsion for overdose: causation or coincidence?

3 out of 5 stars Asystole Immediately Following Intravenous Fat Emulsion for Overdose. Cole JB et al. J Med Toxicol 2014 Feb 12. [Epub ahead of print] Abstract This case paper describes 2 patients who developed asystolic within 60 seconds of being given intravenous fat emulsion (IFE) bolus for treatment of severe cardiotoxicity. Both patients had return of spontaneous circulation (ROSC) after several minutes of cardiopulmonary resuscitation. Unfortunately, both patients died days after admission from multisystem organ failure. Patient A,  a 50-year-old woman, had ingested an undetermined about of metoprolol and bupropion in a suicide attempt. She seized and then developed bradycardia and hypotension unresponsive to multiple interventions (fluid, glucagon, insulin). Within 30 sec of receiving the IFE bolus she had a brady-asystolic arrest. Apparently her hemodynamic status stabilized after ROSC, but she died on hospital day 4. Patient B, a 53-year-old man, ingested 3,600 mg of long-acting diltiazem and 1,200 mg of propranolol. He presented with bradycardia and hypotension. Echocardiogram showed very poor myocardial contractility. There was apparently no sustained response to epinephrine, atropine, calcium, dopamine, and sodium bicarbonate. Hemodynamic parameters did improve with high-dose insulin, but when the bag ran out and there was a delay in replacing it the patient again became bradycardic and hypotensive. He arrested within 1 minutes of receiving IFE. He was apparentl...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical asystole bupropion cardiac arrest diltiazem intralipid intravenous fat emulsion therapy metoprolol propranolol Source Type: news