Dopamine overdose
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Various toxicities in a neonate: case report A 7-day-old baby boy developed various toxicities following an accidental overdose of dopamine. The boy, who had an atrial septal defect and transposition of the great arteries, was administered a dopamine solution infused through his total parenteral nutrition pump. The dopamine was delivered at a dose of 182 µg/kg/min or 15–20 minutes [indication not stated] at which point he developed respiratory distress and the error was detected. Tachycardia (peak HR 170 bpm) and hypertension (peak BP 102/100mm Hg) also occurred. The boy was intubated, and initiated on a bicarbonate drip. An initial analysis of blood gases indicated acidosis, and a cranial ultrasound identified a germinal matrix bleed. His creatinine level peaked at 1.8 mg/dL, and haematological tests demonstrated the following levels: platelets 39 K/mm3, INR 1.8 and haemoglobin 11.9 g/dL. He received transfusions of fresh frozen plasma, RBCs and platelets. His serum AST level reached a peak of 628 IU/L, and then declined over 10 days. He was commenced on milrinone, sodium nitroprusside and alprostadil, with fentanyl and dexmedetomidine for sedation. His lactate level peaked at 23.9 mmol/L, decreasing to 2.1 mmol/L the following morning. A grade 2 intraventricular haemorrhage was observed on a head CT scan. He required extra fresh frozen plasma, as his INR remained at 1.6. A brain MRI was normal on day 15 of life, and by day 18 his laboratory parameters were normal. He was discharged home on day 81 of life. Author comment: "This neonate received [dopamine] at > 3 times the upper limit of normal for 15–20 min". "[This] resulted in hypertension and ensuing [intraventricular haemorrhage], acidosis, ischemic liver injury, and coagulopathy". "No specific therapy exists for [dopamine] toxicity". Kornas RL, et al. Dopamine toxicity and its complications in a neonate Clinical Toxicology 51: 600 abstr. 58, No. 7, Aug 2013. Available from: URL: http:// 803095650 informahealthcare.com/doi/abs/10.3109/15563650.2013.817658 - USA
0114-9954/13/1478-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
Reactions 16 Nov 2013 No. 1478
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