Regions Hospital Clinical Toxicology Service and Department of Emergency Medicine, St. Paul, MN 55101, USA.
Clin Toxicol (Phila). 2010 Mar;48(3):227-9. doi: 10.3109/15563650903555294.
Nebivolol, a beta blocker with 3-10 times more beta1 cardioselectivity than metoprolol, has caused hypotension and bradycardia in overdose. We report a nebivolol-induced cardiac arrest in the setting of a polydrug ingestion, successfully resuscitated with intravenous fat emulsion (IFE) and high-dose insulin (HDI).
A 48-year-old man was brought to the emergency department after ingesting nebivolol and ethanol, along with possibly diazepam and cocaine. He had a heart rate of 71/min and a blood pressure of 98/61 mmHg. The initial ECG showed sinus rhythm with a QTc of 483 ms and a QRS of 112 ms. Over the subsequent 4 h, he became bradycardic and hypotensive and developed bradyasystolic cardiac arrest. Standard resuscitation including epinephrine had no effect. Spontaneous circulation returned 30 s after a 100 mL bolus of 20% IFE, and the patient then became briefly hypertensive and tachycardic with heart rate and blood pressure measured as high as 123/min and 251/162 mmHg, respectively. His care included IFE infusion along with HDI bolus and infusion with doses as high as 21.8 units/kg/h. With subsequent hypotension, vasopressors were withheld in favor of HDI and supportive care. He was discharged with baseline neurologic function.
We hypothesize that after the administration of IFE the epinephrine was able to exert its effect on receptors previously occupied with the nebivolol. This would be congruent with the lipid sink theory of IFE mechanism.
We report an overdose involving nebivolol in a polydrug ingestion resulting in cardiac arrest, successfully treated with IFE and a very HDI infusion.
比索洛尔是一种β受体阻滞剂，其β1 心脏选择性比美托洛尔高 3-10 倍，过量使用会导致低血压和心动过缓。我们报告了一例多药摄入导致的比索洛尔引起的心脏骤停，通过静脉输注脂肪乳（IFE）和高剂量胰岛素（HDI）成功复苏。
一名 48 岁男性因摄入比索洛尔和乙醇，可能还有地西泮和可卡因而被送往急诊科。他的心率为 71 次/分，血压为 98/61mmHg。初始心电图显示窦性节律，QTc 为 483ms，QRS 为 112ms。在随后的 4 小时内，他出现心动过缓和低血压，并发展为心动过缓性心脏骤停。包括肾上腺素在内的标准复苏措施均无效。在 100ml 20%IFE 推注后 30 秒恢复自主循环，患者随后出现短暂性高血压和心动过速，心率和血压分别高达 123 次/分和 251/162mmHg。他的治疗包括IFE 输注以及 HDI 推注和输注，剂量高达 21.8 单位/公斤/小时。随着随后的低血压，为了支持 HDI 和支持性护理，停用了升压药。他出院时神经功能正常。
我们假设在给予IFE 后，肾上腺素能够在先前被比索洛尔占据的受体上发挥作用。这与IFE 作用机制的脂质库理论一致。
我们报告了一例多药摄入导致的比索洛尔引起的心脏骤停，通过IFE 和非常高剂量的胰岛素输注成功治疗。
