Nedelotvornost intravenske emulzije masti u lečenju kardiotoksičnosti izazvane predoziranjem kombinacije lekova uključujući dihidropiridinske blokatore kalcijumovih kanala

  • Jasmina Jović-Stošić National Poison Control Centre, Military medical Academy, Belgrade
  • Vesna Putić National Poison Control Centre, ‡Sector of Pharmacy, Military Medical Academy, Belgrade, Serbia
  • Dragan Živanović National Poison Control Centre Military Medical Academy, Belgrade, Serbia
  • Milica Mladenov National Poison Control Centre Military Medical Academy, Belgrade, Serbia
  • Gordana Brajković National Poison Control Centre Military Medical Academy, Belgrade, Serbia
  • Snežana Djordjević National Poison Control Centre, Military Medical Academy, Belgrade, Serbia Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
DOI: https://doi.org/10.2298/7362
Ključne reči: poisoning||, ||trovanje, suicide||, ||samoubistvo, calcium channel blokers||, ||kalcijum, blokatori, adrenergic beta-antagonists||, ||adrenergički beta blokatori, heart arrest||, ||srce, zastoj, fat emulsions, intravenous||, ||masne emulzije, intravenske,

Sažetak


Uvod. Antagonisti kalcijumovih kanala i beta blokatori predstavljaju najčešće upotrebljavane  kardiološke lekove prilikom samotrovanja koji prouzrokuju značajnu smrtnost. Intravenske emulzije masti (IEM) u poslednje vreme koriste se kao protivotrov u lečenju akutnih trovanja prouzrokovanih ovim lekovima. Prikaz bolesnika. Prikazali smo dva bolesnika otrovana ovim lekovima. Bolesnica, stara 24 godine, popila je tablete amplodipina, metformina i gliklazida u cilju samotrovanja. Klinička slika na prijemu uključivala je tahikardiju i hipotenziju, a laboratorijske analize hiperglikemiju i metaboličku acidozu. I pored terapije koja se sastojala od intravenske primene tečnosti, vazopresora, kalcijuma, glukagona i IEM, razvio se cirkulatorni  šok. Deset časova nakon prijema došlo je do srčanog zastoja refraktornog na mere kardiopulmonalne resuscitacije. Drugi bolesnik, star 41 godinu, nađen je u komi sa ispražnjenim pakovanjima nifedipina, metoprolola i diazepama. Na prijemu, vrednost Glazgovske koma skale (GKS) iznosila je 3, postojao je slab palpabilan puls, krvni pritisak bio je nemerljiv, a disanje nepravilno sa zasićenjem kiseonikom od 60%. Na elektrokardiogramu registrovan je AV blok tipa Mobitz II sa komorskom frekvencijom od 44/min koji progredirao u AV blok III stepena. U terapiji su primenjivani bolusi atropina, fiziološki rastvor sa dopaminom, glukagon, kalcjium hlorid i ILE. Plasiran je privremeni pejsmejker čija se električna aktivnost registrovala, ali nije došlo do popravljanja hemodinamskih parametara. Tri časa nakon prijema došlo je do srčanog zastoja refrakternog na terapiju. Zaključak. IEM mogu biti neefikasne u lečenju akutnih trovanja amlodipinom, nifedipinom i metoprololom.

 

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Objavljeno
2017/01/23
Broj časopisa
Vol. 73 Br. 1 (2016)
Rubrika
Prikaz bolesnika