Intensive Care Department, CHU UCL Godinne Namur, Louvain Medical School, Namur, Belgium.
Intensive Care Unit, IRIS Sud Hospitals, Brussels, Belgium.
Am J Case Rep. 2023 Aug 5;24:e939884. doi: 10.12659/AJCR.939884.
BACKGROUND Tricyclic antidepressant (TCA) drugs are a common cause of fatal poisoning because of their cardiotoxic and arrhythmogenic effects. Classic supportive management includes sodium bicarbonate, gastrointestinal chelating agents, and vasopressors. Recently, intravenous lipid emulsion (supported by a low evidence level) has also been used. CASE REPORT We report the case of a 55-year-old woman admitted to our Intensive Care Unit (ICU) with acute imipramine self-poisoning. She arrived at the emergency department 7 hours after imipramine ingestion; she had severe rhabdomyolysis upon admission, with creatine phosphokinase levels at about 52 500 IU/L (normal, <200 IU/L). She quickly developed cardiogenic shock and malign arrhythmia requiring veno-arterial extra corporeal membrane oxygenation (VA-ECMO). Continuous renal replacement therapy (CRRT) with CytoSorb® (CytoSorbents, Monmouth Junction, New York, United Sates of America) was started 19 hours after admission. We performed serial blood measurements of imipramine and its active metabolite desipramine as well as viewing the levels on the CRRT-circuit monitor. Cardiac function improved and ECMO was explanted after 4 days. She also had severe acute respiratory distress syndrome, which resolved spontaneously. The neurologic outcome was favorable despite early myoclonus. The patient regained consciousness on the fifth day. Her clinical evolution was marked by acute ischemia of the lower left limb due to the arterial ECMO cannula. CONCLUSIONS These measurements document the efficacy of the CytoSorb® adsorber in removing a lipophilic drug from a patient's bloodstream. To our knowledge, this is the first published case of CytoSorb® extracorporeal blood purification therapy for acute TCA poisoning.
三环类抗抑郁药（TCA）因其心脏毒性和致心律失常作用，是导致致命中毒的常见原因。经典的支持性治疗包括碳酸氢钠、胃肠道螯合剂和血管加压药。最近，静脉内脂肪乳剂（基于低证据水平）也已被使用。
我们报告了一例 55 岁女性因急性丙咪嗪中毒被收入我们的重症监护病房（ICU）的病例。她在摄入丙咪嗪后 7 小时到达急诊科；入院时出现严重的横纹肌溶解症，肌酸磷酸激酶水平约为 52500 IU/L（正常值<200 IU/L）。她很快发展为心源性休克和恶性心律失常，需要静脉-动脉体外膜肺氧合（VA-ECMO）。入院后 19 小时开始进行 CytoSorb®（CytoSorbents，Monmouth Junction，New York，USA）连续肾脏替代治疗（CRRT）。我们进行了丙咪嗪及其活性代谢物去甲丙咪嗪的系列血液测量，并观察了 CRRT 回路监测仪上的水平。心脏功能改善，ECMO 在 4 天后被取出。她还患有严重的急性呼吸窘迫综合征，该综合征自行缓解。尽管早期有肌阵挛，但神经系统预后良好。患者在第五天恢复意识。她的临床进展因动脉 ECMO 插管导致左下肢体急性缺血而受到影响。
这些测量结果证明了 CytoSorb®吸附剂从患者血液中去除亲脂性药物的疗效。据我们所知，这是首例使用 CytoSorb®体外血液净化疗法治疗急性 TCA 中毒的病例。
