LipidRescue™ Resuscitation

Propranolol (500 mg) and amlodipine (200 mg) suicidal attempt in 33-year old female w/PMH of HTN, bipolar disorder, mental illness, obesity (weight 161 kg), and chronic headaches. Home medications included amlodipine 10 mg daily PO, propranolol 10 mg TID PO, bupropion 100 mg daily PO, fluphenazine 2.5 mg BID PO, trazodone 100 mg HS PO, and lithium carbonate 300 mg TID PO. Vital signs on admission: BP 78/41, HR 55, glucose 118. Upon ED presentation, received NS bolus 1L x 1. Activated charcoal 25 gm x 1 was administered and gastric lavage was performed (no visible pill fragments noted). Poison Control Center was contacted, where high-dose insulin euglycemia and lipid rescue therapy were recommended. Before lipid rescue, BP 56/28 and HR 69. Patient received lipid emulsion 20% at 1.49 mL.kg.min IVPB x 1 for 1 min, followed 5 min later with 0.25 mL/kg/min IVPB x 1 for 10 min. Vitals 30 min later were BP 56/28 and HR 74, and patient received second lipid emulsion 20% of 1.49 mL/kg/min IVPB x 1 for 1 min. Vitals 20 min later were 78/32 HR 79, vitals 1 hour later were BP 90/34 HR 81. Patient was started on vasopressors (norepinephrine and dopamine) and subsequently transferred to ICU. Throughout the day, BP improved to 100s systolic, HR 70s - 80s. Norepinephrine, dopamine, and insulin drips were weaned the next two days, and patient transferred to inpatient psychiatric unit on day # 3.