Successful treatment of polymedicamentous poisoning with metoprolol, diltiazem and cilazapril

Abstract

Introduction. Poisoning caused by drugs with cardiodepressive effects is an urgent condition in medicine which is associated with high mortality rate regardless of modern therapeutic methods. Accidental or intentional poisoning whit these drugs produces heart activity depression and cardiovascular collapse as consequences. Current therapy for severe poisoning caused by beta-blockers and calcium channel blockers includes both unspecific and specific antidote therapy whit glucagon, as well as application of adrenergic drugs, calcium, phosphodiesterase inhibitors and hyperinsulinemia/euglycemia therapy. However, even whit the application of these drugs, prompt measures of unspecific detoxication therapy and cardiopulmonary reanimation are crucial for survival of patients with severe poisoning. Case report. A 28-year-old female patient was hospitalized for cardiogenic shock and altered state of conscioussnes (Glasgow coma score = 4), caused by acute poisoning with 2 g of metoprolol (Presolol?), 1.8 g of diltiazem (Cortiazem?) and 50 mg of cilazapril (Zobox?). Prolonged cardiopulmonary resuscitation was applied during the first 16 hours of hospitalization, including administration of crystaline solutions (8 L), 17 mg of adrenaline, 4 mg of atropine, 4 mg of glucagone and 1.6 g of dopamine, with electro-stimulation by temporary pacemaker and mechanical ventilation. In a defined time period, normalized state of consciousness was registered, mechanical ventilation was stopped and normal heart activity and hemodynamic stability were accomplished. During hospitalization the patient was treated for mild pneumonia and after ten days, completely recovered, was released and sent to home treatment. Conclusion. Prompt measures of cardiopulmonary resuscitation and multidisciplinary treatment in intensive care units significantly increase the chances of complete recovery of a patient with severe poisoning caused by drugs with cardiodepressive efects.Uvod. Trovanje lekovima sa kardiodepresivnim dejstvom je urgentno stanje u medicini koje se, i pored savremenog terapijskog pristupa, karakterise visokim mortalitetom. Zadesna ili namerna trovanja ovim lekovima imaju za posledicu depresiju srcane aktivnosti i kardiovaskularni kolaps. Savremenu terapiju teskih trovanja beta blokatorima i blokatorima kalcijumskih kanala, pored nespecificne, cini i specificna antidotska terapija glukagonom, kao i primena adrenergickih lekova, kalcijuma, inhibitora fosfodiesteraze i insulina primenjenog u obliku hiperinsulinemija/euglikemija terapije. Medjutim, i pored primene savremenih lekova presudni znacaji za prezivljavanje tesko otrovanih imaju pravovremene mere nespecificne detoksikacione terapije i kardiopulmonalne reanimacije. Prikaz bolesnika. U radu je prikazana bolesnica, stara 28 godina, hospitalizovana zbog kardiogenog soka i poremecenog stanja svesti (Glazgov koma skor = 4) uzrokovanih akutnim trovanjem zbog uzimanja 2 g metoprolola (Presolol?), 1,8 g diltiazema (Cortiazem?) i 50 mg cilazaprila (Zobox?). Kod bolesnice je sprovedena produzena kardiopulmonalna reanimacija tokom prvih 16 sati hospitalizacije koja je ukljucivala primenu 8 L infuzionih rastvora, 17 mg adrenalina, 4 mg atropina, 4 mg glukagona i 1,6 g dopamina, uz elektrostimulaciju privremenim pejsmejkerom i primenu mehanicke ventilacije. U definisanom vremenskom periodu registrovano je normalizovanje stanja svesti, obustavljena je mehanicka ventilacija, uspostavljena normalna srcana aktivnost i hemodinamska stabilnost. Tokom hospitalizacije bolesnica je lecena od lakseg oblika pneumonije, a nakon deset dana potpuno oporavljena upucena je na kucno lecenje. Zakljucak. Brzo pruzanje prve pomoci, sprovodjenje mera nespecificne detoksikacije, pravovremeno zapocinjanje mera kardiopulmonalne reanimacije i multidisciplinarno lecenje u jedinicama intenzivne nege znacajno povecava izglede za potpuno izlecenje bolesnika sa teskim oblicima polimedikamentoznih trovanja lekovima sa kardiodepresivnim dejstvom.