Multiple drugs
- PDF / 170,811 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 1 Downloads / 141 Views
1 OS
Various toxicities: case report A 74-year-old woman developed two large pharmacobezoars, first degree atrioventricular (AV) block, Mobitz type-1 second degree AV block, pulseless electrical activity, vomiting and somnolence secondary to multiple drugs overdose after the intentional ingestion of diltiazem, fluoxetine, ibuprofen, pravastatin, ranitidine, omeprazole, lisinopril and aspirin. Later, she exhibited lack of efficacy with atropine, calcium chloride, calcium gluconate, sodium chloride, glucagon, insulin, vasopressin, epinephrine and norepinephrine [not all routes and dosages stated]. The woman had a history of depression, bipolar disorder, a prior suicide attempt, hypertension, hyperlipidaemia and gastroesophageal reflux disease. Approximately 1 hour after the intentional ingestion of all her medications, she presented to the emergency department. Her ingested medications included extended release diltiazem capsules, fluoxetine, ibuprofen, pravastatin, ranitidine, omeprazole, lisinopril and aspirin. At the time of presentation, she was noted as alert, awake and oriented, but slightly somnolent. Subsequently, she had several episodes of large volume emesis that exclusively contained pills and fragments of pills. On examination of vomitus, two large pharmacobezoars were noted. The contents of bezoars were identified as undigested diltiazem capsules coalesced with partially digested ranitidine tablets. Involvement of other ingested drugs in the bezoar formation was not identified. At the time of presentation, her HR was noted as 72 beats/min and BP as 121/72mm Hg. An ECG showed first degree AV block with PR interval of 264ms. Approximately, 80 minutes after the ECG, a second ECG showed normal sinus rhythm with a Mobitz type-I second degree AV block. Therefore, the woman was prophylactically intubated (tracheal intubation). Gastric lavage was performed, followed by whole bowel irrigation with polyethylene glycol via an orogastric tube. Additionally, she received IV calcium gluconate 3g and sodium chloride [isotonic fluids]. However, as her condition continued to deteriorate, she was shifted to ICU. Additional treatments included atropine, calcium chloride, glucagon, insulin, transcutaneous pacing, vasopressor support with vasopressin, epinephrine and norepinephrine. Despite the treatments, her condition continued to deteriorate, and she experienced an episode of pulseless electrical activity (within 12 hours of drug ingestion). Cardiopulmonary resuscitation and IV lipid emulsion therapy were initiated, but she died [immediate cause of death not stated] Goldberger D, et al. Massive polypharmacy overdose resulting in diltiazem pharmacobezoar formation. Clinical Toxicology 58: 626 abstr. 261, No. 6, May 2020. Available 803503321 from: URL: http://doi.org/10.1080/15563650.2020.1741981 [abstract]
0114-9954/20/1823-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 26 Sep 2020 No. 1823
Data Loading...
