Multiple drug overdose
- PDF / 153,093 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 73 Downloads / 145 Views
1 OS
Multiple drug overdose Heart failure, left ventricular dysfunction and weight loss following multiple drug abuse: case report
A 52-year-old man experienced heart failure, left ventricular (LV) dysfunction and weight loss following abuse and overdose of caffeine/chlorphenamine/dihydrocodeine/methylephedrine/paracetamol. The man presented to hospital with anorexia, weight loss and worsening dyspnoea for 2 weeks. Following a detailed medical interview, it was revealed that he was a night shift worker and he had been habitually consuming 3–4 bottles (90–120mL) of methylephedrine-containing paediatric OTC cough syrup daily for 20 years (recommended dose 7.5 mL/day for paediatric patients) as a revitaliser. Each bottle of the caffeine/chlorphenamine/dihydrocodeine/methylephedrine/paracetamol syrup contained methylephedrine 40mg, caffeine 50mg, chlorpheniramine 5mg, dihydrocodeine 16mg and paracetamol [acetaminophen] 450mg. On admission, his BP was 146/98mm Hg, while his HR was 104 bpm. Chest X-ray demonstrated pulmonary congestion, while electrocardiogram showed sinus tachycardia with left-axis deviation. Echocardiography revealed diffuse hypokinesis of the left ventricle with a reduced ejection fraction (EF) of 25% and an increased LV end-diastolic diameter at 67mm, suggestive of LV dysfunction. Laboratory analyses revealed elevated B-type natriuretic peptide and liver enzymes, indicating liver congestion. The man’s caffeine/chlorphenamine/dihydrocodeine/methylephedrine/paracetamol cough syrup was discontinued immediately after admission. Although his vital signs were relatively stable, he was diagnosed with decompensated heart failure, and he started receiving a low-dose dobutamine infusion for low cardiac output symptoms. However, even after treatment with furosemide and low-dose dobutamine in the ICU, right-heart catheterisation revealed a ’wet and cold’ profile, with a mean pulmonary artery pressure of 29mm Hg, pulmonary capillary wedge pressure of 22mm Hg and cardiac index of 1.89 L/min/m2. Coronary angiography showed normal coronary arteries; however, left ventriculography demonstrated severe diffuse hypokinesis with mild mitral regurgitation. Pathological examination by right ventricular endomyocardial biopsy showed cardiomyocyte hypertrophy with moderate interstitial and replacement fibrosis, with absence of secondary cardiomyopathies and myocarditis. Additionally, cardiac MRI demonstrated diffuse hypokinesis with mid-wall late gadolinium enhancement, suggestive of fibrosis. Discontinuation of the cough syrup and optimal medical treatment (OMT) with an unspecified angiotensin-converting enzyme inhibitor and an unspecified β-blocker improved his heart failure symptoms to New York Class Association Class-II at 4 months post discharge. His EF also improved to 50%. LV reverse remodelling was achieved. Additionally, his BNP levels decreased and normalised. The pathological changes in the myocardium were attributed to the methylephedrine as well as the caffeine content of the syrup. Of note, although his weight
Data Loading...
