Chan Betty S, Becker Therese, Chiew Angela L, Abdalla Ahmed M, Robertson Tom A, Liu Xin, Roberts Michael S, Buckley Nicholas A
Clinical Toxicology Unit & Emergency Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.
School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
J Med Toxicol. 2018 Mar;14(1):100-103. doi: 10.1007/s13181-017-0637-1. Epub 2017 Nov 13.
Management of severe vasoplegic shock in overdose can be very challenging. We describe a case of severe refractory vasodilatory shock in poisoning where methylene blue (MB) was used with success. However, the patient subsequently developed severe Serotonin Syndrome (SS) as a result of an interaction between serotonergic drugs and MB.
A 15-year-old male developed severe vasoplegic shock 1.5 hours after overdosing on several different medications including quetiapine slow release, quetiapine immediate release, desvenlafaxine slow release, venlafaxine, amlodipine, ramipril, fluoxetine, promethazine and lithium. His vasoplegic shock was resistant to high doses of noradrenaline and vasopressin. MB was administered 6.5 hours post ingestion and within 1 hour there was an improvement in his hemodynamic status and reduction of catecholamine requirements. Twelve hours post ingestion, he developed severe Serotonin Syndrome that lasted 5 days as a result of interaction between MB, a reversible monoamine oxidase inhibitor (MAO-I), and the antidepressants taken in overdose. MB had a calculated half-life of 38 hours.
MB is a useful additional strategy for severe drug induced vasodilatory shock and may be potentially life-saving. Clinicians should be aware that it can interact with other drugs and cause life-threatening Serotonin Syndrome. Lower doses or shorter durations may be wise in patients at risk of this interaction.
药物过量所致严重血管麻痹性休克的管理极具挑战性。我们描述了一例中毒导致的严重难治性血管舒张性休克病例，亚甲蓝（MB）治疗成功。然而，患者随后因血清素能药物与MB相互作用而发生严重血清素综合征（SS）。
一名15岁男性在过量服用多种不同药物（包括缓释喹硫平、速释喹硫平、缓释去甲文拉法辛、文拉法辛、氨氯地平、雷米普利、氟西汀、异丙嗪和锂）1.5小时后发生严重血管麻痹性休克。他的血管麻痹性休克对高剂量去甲肾上腺素和血管加压素耐药。摄入后6.5小时给予MB，1小时内其血流动力学状态改善，儿茶酚胺需求量减少。摄入后12小时，由于MB（一种可逆性单胺氧化酶抑制剂（MAO-I））与过量服用的抗抑郁药相互作用，他发生了严重血清素综合征，持续5天。MB计算半衰期为38小时。
MB是治疗严重药物性血管舒张性休克的一种有用的附加策略，可能挽救生命。临床医生应意识到它可与其他药物相互作用并导致危及生命的血清素综合征。对于有这种相互作用风险的患者，较低剂量或较短疗程可能是明智的。
