Journal of medical toxicology : official journal of the American College of Medical Toxicology
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The use of intravenous lipid emulsion (IVLE) has been proposed as a new potential treatment for local anesthetic toxicity. Local anesthetics work through reversible binding at sodium channels, and signs and symptoms of toxicity include central nervous system and cardiovascular effects. Cardiovascular collapse is a potential result of local anesthetic toxicity, and is generally resistant to resuscitation efforts with standard measures. ⋯ IVLE has shown to be an interesting prospect for local anesthetic toxicity. Human case reports have shown successful resuscitation with use of IVLE, using varying dosing regimens. More studies are needed to determine the optimal dosing regimen, as well as to determine the potential adverse effects of IVLE when used in this setting.
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Amantadine hydrochloride is an antiviral medication used as therapy for parkinsonism and as a cognitive enhancer. We report 2 cases of massive, acute ingestion of amantadine hydrochloride confirmed with serial serum levels. ⋯ Acute amantadine toxicity manifests with life-threatening cardiotoxicity. Concurrent, often profound, hypokalemia may complicate the administration of sodium bicarbonate in the management of cardiac dysrhythmias.
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Unintentional methotrexate (MTX) acute oral overdose is rarely reported. ⋯ Although intravenous MTX toxicity can be severe, this does not appear to be a phenomenon associated with either acute unintentional or suicidal oral ingestion.
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Case Reports
Citalopram overdose: late presentation of torsades de pointes (TdP) with cardiac arrest.
Citalopram overdose may produce bradycardia, QT prolongation, and torsades de pointes (TdP). A cardiotoxic metabolite may be responsible for the delayed onset of cardiotoxicity. Although some authorities recommend a minimum of 24 hours of observation following citalopram overdose, a recent analysis suggested that dysrhythmias rarely occur beyond 13 hours post-ingestion. We present a case of citalopram overdose with a substantially delayed onset of cardiac toxicity. ⋯ Citalopram overdose can produce life-threatening cardiac toxicity with a clinical onset that may be delayed beyond a routine observation period of 6 hours. Once the QT interval is prolonged, it seems prudent to prolong the observation period.
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Intravenous fat emulsions (IFE) are traditionally used as a component of parenteral nutrition therapy. Recently, IFE was used to resuscitate severe local anesthetic drug toxicity. ⋯ Cases of local anesthetic toxicity treated with IFE are presented along with a discussion of the possible antidotal mechanisms. Initial investigations into the antidotal use of IFE for lipophilic central nervous and cardiovascular drug toxicity are also reviewed.