LipidRescue™ Resuscitation

16 years old female was admitted to ICU, history of attempted suicide was given. Patient was intubated in casualty, 20 mg of diazepam in total was given to control seizures. In ICU patient was tachycardic but mantained blood pressure, continued seizing. 100 mg of thiopentone was administered i.v. and controlled ventilation started. After 5 minutes she had cardiac arrest. CPR was started, epinephrine administered. After 15 minutes of resuscitation we observed VF and patient was defibrillated, rythm changed to PEA. More detailed history was told by relatives, patient took unknown amount of amitryptyline and diclofenac tablets. Intralipit bolus of 96 ml was given followed by infusion of remaining 400 ml and multiple boluses of NaHCO3 administered. After CPR lasting 35 minutes a carotid artery pulse was palpable. Patient required epinephrine infusion rate 0.1 mcg/kg/minto mantain mean blood pressure of 50 mmHg. After 2 hours VT episode was observed and amiodaron 150 mg was given and patient converted to sinus rythm. Next day epinephrine dose was decreased to 0.04 mcg/kg/min and stopped the following day. She was able to mantain blood pressure. Patient was awake on the third day, GSC 15/15, and was discharged from ICU the same day and referred to psychiatric services.

Interesting Case with a good outcome.The clinical course is compatible with TCA overdose.Toxicity associated with seizures has a 13% mortality according to Goldfrank's textbook.I would be interested in blood gas analysis to determine the state of acidosis.I assume this must have been considerable if multiple NaHCO3 doses were required. Was the patient hyperthermic (possible anticholinergic effect) or hypothermic? We have experience of a slow recovery in a patient with a core temperature of 35.5 deg C following overdose and intralipid. I know Dr Weinberg would join me in asking you to post the case details on the Lipid Registry sister website.

Unfortunately, we only got blood gas results after resuscitation, showed metabolic acidosis, pH 7.22. NaHCO3 was administered because of prolonged rescscitation time and then to increase pH to decrease TCA toxicity. Patient was normotermic. During CPR 5 mg of epinephrine was administered. We were surprised that patient completely recovered neurologicaly intact. She couldn`t remember last 3 days and that was all. Considering long CPR, delay in intralipid use patient recovery was fast and complete.
Will you give me details about Lipid Registry sister website mentioned in Dr David Uncles post ?.