Propofol abuse
- PDF / 142,465 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 8 Downloads / 205 Views
1
S
Brugada-like ECG pattern and death following recreational propofol abuse: case report A 26-year-old man, who was an anaesthesiology trainee, experienced a Brugada-like ECG pattern and died after recreational abuse of propofol [dosage, duration of abuse and time to reaction onset not stated]. The man was found unconscious in his bed with a needle canalised into a vein in his forearm, which was attached to an empty syringe. He was intubated and referred to an ICU. An ECG revealed a Brugada pattern in V1–V3. He had profound hypotension (systolic BP 70mm Hg) and metabolic acidosis (pH 7.18, pO2 85mm Hg, pCO2 27.5mm Hg, bicarbonate 16 mEq/L). The man received norepinephrine [noradrenaline] and fluid replacement, but his hypotension did not improve. He had a serum triglyceride level of 670 mg/dL, a potassium level of 4.4 mEq/L and a sodium level of 132 mEq/L. Half an hour after admission, he developed a prolonged QT interval, ventricular fibrillation and idiopathic ventricular rhythm. He received prolonged CPR, but he died. Coworkers knew about his propofol abuse. Autopsy findings included the following: multiple needle marks on his forearms and hands, increased brain weight, increased lung weight and white foam in the main bronchi. Histological examination of the lungs showed massive pulmonary oedema. Analysis of the heart revealed myocell hypercontraction and breakdown of the contractile apparatus with short sarcomeres and thickened Z-lines. There was also foci or myocardial contraction band necrosis or coagulative myocytolysis in all of the heart regions. Liver analysis showed mild necrosis in acinar zone 3 and the pancreas had mild cellular autolysis. The kidney had tubular epithelium necrosis, dilated distal tubules with flattened lining and a lumen filled with granular casts. Immunohistochemistry findings were positive for TUNEL and intensely positive TNF-α assays in the heart samples. Toxicological analysis was positive for benzodiazepines. He had total propofol concentrations of 0.90, 1.70, 0.12, 0.70, 0.21 and 2.80 µg/mL in his blood, urine, liver, kidney, brain and bile, respectively. Analysis of his hair revealed propofol concentrations of 0.73 µg/g (0–2 cm from epidermus), 0.59 µg/g (2–4 cm from epidermus) and 0.68 µg/g (4–6 cm from epidermus), indicating that he was a long-term propofol abuser. Riezzo I, et al. Brugada-like EKG pattern and myocardial effects in a chronic 801158318 propofol abuser. Clinical Toxicology 47: 358-363, No. 4, 2009 - Italy
0114-9954/10/1284-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 16 Jan 2010 No. 1284
