RESUMEN
A 34-year-old man ingested an excessive amount of pilsicainide hydrochloride (Sunrythm, total dose, 2,500 mg) with suicide attempt. On admission, consciousness was impaired and circulatory failure was evident. Systolic blood pressure was 74 mmHg. As electrocardiography (ECG) revealed ventricular tachycardia (VT), cardioversion was administered but was unsuccessful. We therefore administered magnesium sulfate. This resulted in immediate reversion to normal rhythm; however, PQ and QRS intervals remained prolonged, consistent with the effects of a Vaughan Williams class I c Na-channel blocker. Blood pressure rose to over 100 mmHg, and circulatory and respiratory function improved immediately. Plasma concentration of pilsicainide hydrochloride was markedly increased to 7.22 microg/mL (therapeutic range: 0.2 approximately 1.0 microg/ mL) on admission. We performed direct hemoperfusion (DHP) to reduce pilsicainide concentration. DHP was performed twice, and drug concentration was measured each time. DHP was insufficiently effective for reducing plasma pilsicainide concentration. In conclusion, administration of magnesium sulfate is an effective therapy for Pilsicainide-induced ventricular tachycardia.
Asunto(s)
Antiasmáticos/envenenamiento , Lidocaína/análogos & derivados , Sulfato de Magnesio/administración & dosificación , Taquicardia Ventricular/etiología , Taquicardia Ventricular/terapia , Adulto , Sobredosis de Droga , Hemoperfusión , Humanos , Infusiones Intravenosas , Lidocaína/sangre , Lidocaína/envenenamiento , Masculino , Intento de Suicidio , Resultado del TratamientoAsunto(s)
Acetatos/envenenamiento , Antiasmáticos/envenenamiento , Quinolinas/envenenamiento , Acetatos/farmacología , Antiasmáticos/farmacología , Ciclopropanos , Sobredosis de Droga , Servicios Médicos de Urgencia , Femenino , Humanos , Lactante , Antagonistas de Leucotrieno , Quinolinas/farmacología , SulfurosAsunto(s)
Intoxicación/etiología , Antiasmáticos/envenenamiento , Antibacterianos/envenenamiento , Antidepresivos/envenenamiento , Antitusígenos/envenenamiento , Benzodiazepinas/envenenamiento , Niño , Anticonceptivos Orales/envenenamiento , Antagonistas de los Receptores Histamínicos H1/envenenamiento , Humanos , Hierro/envenenamiento , Informática Médica , Descongestionantes Nasales/envenenamiento , Intoxicación/terapia , Vitaminas/envenenamientoRESUMEN
The leukotriene receptor antagonists (LTRAs) is a relatively new class of asthma medication with a lack of toxicity for unintentional poisoningsituations. This makes it difficult to determine which exposures require aggressive decontamination or simple monitoring in the home setting: prompting the question, "What LTRA dose is likely to produce significant toxicity?" We report a case of an unintentional poisoning with 80 mg montelukast in a 3-y-o asthmatic child that was managed in the home with observation alone and a second case of untentional 135 mg montelukast poisoning in a 5-y-o asthmatic child managed in an emergency department. In both cases, symptoms were not observed. These cases and available literature suggest that doses < 4.5 mg/kg in children result in minimal toxicity.