• Jasmina Jovic-Stosic, Branko Gligic, Vesna Putic, Gordana Brajkovic, and Radenko Spasic.
• Clinic for Emergency and Clinical Toxicology, Military Medical Academy, Crnotravska 17, Belgrade, Serbia. stosic.sajt@sbb.rs
• Clin Toxicol (Phila). 2011 Jun 1;49(5):426-30.

BackgroundPropranolol is a highly lipid-soluble beta-blocker. We describe a case of severe propranolol overdose, with atypical dysrhythmia--wide complex tachycardia--which was successfully treated with lipid emulsion.Case ReportA 31-year-old woman ingested approximately 3.6 g of propranolol along with ethanol. Clinical manifestations of poisoning included coma, seizures, respiratory failure, hypoglycaemia, circulatory shock, and dysrhythmias. An ECG revealed nonspecific intraventricular conduction delay, followed by wide complex supraventricular tachycardia. Toxicological analysis of blood showed ethanol 2.42 g/L and propranolol 4.21 mg/L. The patient responded poorly to conventional therapy, so intravenous lipid emulsion was used. Apart from IV dopamine, the only treatment after the onset of wide complex tachycardia was 20% Intralipid. Transient improvement was noticed after the initial dose of 500 mL; during the infusion of further Intralipid, blood pressure returned to normal and sinus rhythm was re-established.ConclusionWe believe that lipid emulsion had a beneficial effect in the treatment of propranolol toxicity.

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