用合成血管紧张素II输注治疗氯氮平过量引起的血管升压药难治性休克。
Vasopressor-Refractory Shock From Clozapine Overdose Treated With Synthetic Angiotensin II Infusion.
作者信息
Wieruszewski Patrick M, Nelson Sarah, Wittwer Erica D, Leung Jonathan G
机构信息
Department of Pharmacy, Mayo Clinic, Rochester, MN.
Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Laboratory, Mayo Clinic, Rochester, MN.
出版信息
Crit Care Explor. 2020 Sep 14;2(9):e0185. doi: 10.1097/CCE.0000000000000185. eCollection 2020 Sep.
BACKGROUND
Clozapine is an atypical antipsychotic with potent alpha-adrenergic blocking properties when administered at high dosages, resulting in vasodilatory shock in overdose settings.
CASE SUMMARY
A 39-year-old man presented with profound catecholamine- and vasopressin-refractory vasodilatory shock following massive clozapine ingestion. Angiotensin II was initiated when the patient was requiring 2.2 µg/kg/min norepinephrine equivalents of vasopressor support, resulting in a prompt increase in the perfusion pressure. All vasopressors were liberated within 18 hours of angiotensin II initiation, and the patient was discharged with no deficits.
CONCLUSIONS
Synthetic angiotensin II may represent a therapeutic option for refractory hypotension resulting from high dosages of clozapine or other potent alpha-adrenergic blocking medications.
背景
氯氮平是一种非典型抗精神病药物，高剂量使用时具有强大的α-肾上腺素能阻断特性，在过量服用情况下会导致血管舒张性休克。
病例摘要
一名39岁男性在大量摄入氯氮平后出现严重的儿茶酚胺和血管加压素难治性血管舒张性休克。当患者需要2.2μg/kg/min去甲肾上腺素等效剂量的血管升压药支持时开始使用血管紧张素II，灌注压迅速升高。在开始使用血管紧张素II后的18小时内停用了所有血管升压药，患者出院时无后遗症。
结论
合成血管紧张素II可能是治疗因高剂量氯氮平或其他强效α-肾上腺素能阻断药物导致的难治性低血压的一种治疗选择。
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