严重普萘洛尔和乙醇中毒伴宽复合性心动过速，采用静脉内脂肪乳剂治疗：病例报告。

Severe propranolol and ethanol overdose with wide complex tachycardia treated with intravenous lipid emulsion: a case report.

机构信息

Clinic for Emergency and Clinical Toxicology, Military Medical Academy, Crnotravska 17, Belgrade, Serbia.

出版信息

Clin Toxicol (Phila). 2011 Jun;49(5):426-30. doi: 10.3109/15563650.2011.583251.

DOI:10.3109/15563650.2011.583251

PMID:21740142

Abstract

BACKGROUND

Propranolol 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 REPORT

A 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.

CONCLUSION

We believe that lipid emulsion had a beneficial effect in the treatment of propranolol toxicity.

摘要

背景

普萘洛尔是一种高度脂溶性的β受体阻滞剂。我们描述了一例严重的普萘洛尔过量中毒病例，表现为非典型心律失常——宽复合性心动过速，经脂肪乳剂成功治疗。

病例报告

一名 31 岁女性摄入约 3.6 克普萘洛尔和乙醇。中毒的临床表现包括昏迷、癫痫发作、呼吸衰竭、低血糖、休克和心律失常。心电图显示非特异性室内传导延迟，随后出现宽复合性室上性心动过速。血液毒理学分析显示乙醇 2.42 g/L 和普萘洛尔 4.21 mg/L。患者对常规治疗反应不佳，因此使用静脉内脂肪乳剂。除了静脉内多巴胺外，宽复合性心动过速发作后的唯一治疗方法是 20%Intralipid。初始剂量 500 毫升后观察到短暂改善；在进一步输注 Intralipid 期间，血压恢复正常并恢复窦性节律。