%0 Journal Article
%T Extra-corporeal life support for near-fatal multi-drug intoxication: a case report
%A Roberto Rona
%A Barbara Cortinovis
%A Roberto Marcolin
%A Nicol¨° Patroniti
%A Stefano Isgr¨°
%A Chiara Marelli
%A Roberto Fumagalli
%J Journal of Medical Case Reports
%D 2011
%I BioMed Central
%R 10.1186/1752-1947-5-231
%X A 36-year-old Caucasian man presented to our hospital with refractory hypotension, severe cardiac insufficiency and multi-organ failure due to mixed intoxication with atenolol, nifedipine, Lacidipine and sertraline. Together with standard treatment, we performed extra-corporeal membrane oxygenation to overcome refractory cardiogenic shock and lead the patient to achieve a full recovery.Standard of care for ¦Â-blocker and calcium channel blocker intoxication is well-defined and condensed into protocols of treatment. Although aimed at clearing the noxious agents from the patient's system, standard measures may fail to provide adequate hemodynamic support to allow recovery. In selected cases, extra-corporeal membrane oxygenation could be considered a bridge to drug clearance while preventing multi-organ failure due to profound shock.¦Â-blocker (BB) and calcium channel blocker (CCB) are the most common cardiovascular medication classes reported in the database of the American Association of Poison Control Centers Toxic Exposure Surveillance System [1]. BB overdose represents about 1% of patients with drug intoxication admitted to intensive care units. Fatalities are rare but not negligible, with a reported rate of about 0.5% and about 20 deaths per year in the United Kingdom. CCB and BB poisoning represent more than 65% of overall deaths caused by cardiovascular medications [2].The most severe forms, which account for 20% of all BB overdoses, are usually due to propranolol ingestion because of its rapid absorption. In the American experience, propranolol is responsible for the majority of fatal cases (70%), followed by atenolol (20%). The patients' clinical presentation and care in cases of significant BB overdose are a direct consequence of cardiovascular depression and the need to reverse it. Critical factors are timing, type and dosage of the product ingested, the presence of a synergistic co-ingestant, medical co-morbidities and the patient's intent in ingesting the m
%U http://www.jmedicalcasereports.com/content/5/1/231