Post Your Cases > Successful use of intralipid in suspected large PO methamphetamine ingestion
PO ingestion of large (~1-2g) of PO methamphetamine with concomitant ingestions of heroin PO. Presented to ED with sympathomimetic toxicity. GCS dropped with hypotension. Patient intubated for protection of the airway. Ongoing hypotension. Na channel blockade pattern on ECG, bolused with 3 amps Na bicarb and infusion with D5W/Na bicarb (3amp/L) at 250cc/hr. Ongoing hypotension with correction of pattern. Central temp registered at 40.9. Active external cooling of the patient. Ongoing hypotension confirmed with art line placement. Bedside echo suggestion of apical dysfunction of the myocardium. Repeat ECG shows STEMI with diffuse LAD territory ischemic pattern. Ongoing hypotension with systolic of 60 ... cooling effective, temp now 39.5C. Bolus of ILE administered (100cc) -- systolic of 85 within 5 minutes. With ongoing infusion, pressure of 95 systolic and resolution of ST elevation. Subsequent hsTni of >6000 with CK > 5000. Discharged neurologically normal from ICU on day 4.
September 13, 2016 |
Dr. S Mondoux
Dr. S Mondoux
Thanks for posting this impressive save, Shawn. Congratulations for saving this patient's life. What a great job. It's especially interesting to me that ILE was started after the STEMI. Studies in dogs, rabbits, mice, rats and rat primary cardiomyocytes show that ILE attenuates ischemia reperfusion injury by activating Akt and other signals in the RISK kinase cascade. I've always wondered if this contributed to some of the benefit of ILE in helping patients recover from pharmacotoxicity with cardiovascular collapse. Anyway, I'm very glad to see the patient walked away from this neurologically intact.
November 1, 2016 |
[Guy Weinberg]
[Guy Weinberg]