Octreotide
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Asystolic events in an elderly patient: case report A 65-year-old woman developed asystolic events while receiving octreotide to control upper gastrointestinal (GI) bleeding. The woman presented with a 2-week history of melaena, epigastric discomfort, presyncope and coffee-ground emesis; 500mL of bright red blood was found on nasogastric lavage. She was administered pantoprazole and an octreotide infusion at 50 µg/h. An attempt at upper GI endoscopy was unsuccessful and she was admitted to the ICU, sedated on a propofol drip and intubated. A duodenal ulcer was revealed on endoscopy, and she received treatment. On day 2, she developed a bradycardic rhythm that quickly deteriorated into asystole, lasting for 10 seconds. The woman was administered cardiopulmonary resuscitation which restored normal sinus rhythm. She was placed on a scopolamine patch and given atropine as needed. Consultation with the cardiac service established that the event was likely drug-related, either to propofol or octreotide. Propofol was changed to midazolam, but the octreotide infusion was continued due to the GI bleed. On day 3, two more asystolic events and multiple bradycardic episodes occurred, all of which were responsive to atropine. Octreotide was withdrawn, and there were no more asystolic or bradycardic episodes. The remainder of her hospital stay was uneventful. Author comment: "The temporal correlation between the onset and the termination of the cardiac effects with the initiation and discontinuation of the octreotide infusion suggested a causal relationship". Yuhico LSO, et al. Octreotide-induced asystolic events in an intensive care unit patient with gastrointestinal bleeding. Heart and Lung 41: e18-e20, No. 6, Nov 2012. Available from: URL: http://dx.doi.org/10.1016/j.hrtlng.2012.04.010 803082021 USA
0114-9954/10/1434-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 12 Jan 2013 No. 1434
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