Phentolamine overdose/propofol
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Various toxicities: case report A 43-year-old man developed distributive shock, tachycardia, seizures and metabolic acidosis following overdose of phentolamine. Additionally, he developed propofol infusion syndrome (PRIS) during treatment with propofol [routes not stated; not all dosages stated]. The man was admitted to the ICU for phentolamine overdose with presenting symptoms of distributive shock, seizures and tachycardia. The man was intubated and sedated with midazolam. Laboratory results showed significant result for metabolic acidosis with pH 7.21 and lactate 6.6 mmol/L. After six hours of hospital admission and after being treated with levitiracetam, lorazepam and unspecified vasporessors, his pH 7.38 and lactate levels 1.8 mmol/L were normalised. The sedation was changed to propofol at 20–60 µg/kg/min. After 21 hours of admission, he acutely developed hypotension, relative bradycardia, ventricular dyssynchrony and a Brugada-like ECG pattern. Laboratory tests showed significant result for lactate 8.6 mmol/L, pH 7.19, creatinine from 1.9 to 2.1 mg/dL, urine output (UOP) of 1.3 to 0.80 cc/kg/hr and creatinine phosphokinase of 443 to 3068 IU/L. He started receiving treatment with unspecified broad spectrum antibacterials, lung protective ventilation along with sedation (Richmond agitation sedation scale goal of 5) using propofol up to 80 µg/kg/min, fentanyl and midazolam boluses. Cardiac enzymes showed negative result and myocardial depression was not evident on transthoracic echocardiogram. However, his pressor requirement rapidly increased. At this point, PRIS was considered to be causing a new shock. As a result, the therapy with propofol was discontinued. The treatment with methylthioninium chloride [methylene blue], carnitine and sodium bicarbonate was provided. After five hours of interventions, he showed improvements in lactate level, pH, UOP with a normal ECG and decreased vasopressor requirements. Graham A, et al. Is too little too much? A perplexing case of propofol infusion syndrome. American Journal of Respiratory and Critical Care Medicine 199: A6637 (plus 803446852 poster), No. 9, May 2019. Available from: URL: https://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A6637 [abstract]
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Reactions 18 Jan 2020 No. 1787
