Post Your Cases > lipid emulsion for beta blocker intoxication

A 30 year old patient presented to the ED by ambulance after taking 100 tablets of inderal 20 mg 2 hours before arrival. Upon arrival in the ED , the patient has a first epileptic insult ( no known epilepsy, no prior insults in ambulance) at the front desk and doesn't regain consciousness afterwards. Temesta 4 mg is given iv for status epilepticus. Monitorin show pulse at 30 bpm, BP unable to measure, sat 78% GCS 3/15. The patient is intubated, adrenaline and atropine are given to boost BP and pulse with no effect. Transcutanian pacing is started. Glucagon is gathered from different posts in the hospital and a first dose of 3 mg is given IV. Since no more glucagon is available at this moment insuline therapy is started at 1IU / kg combined with glucose 10% solution. Half an hour later the patient goes into VT and is resuscitated following ERC guidelines for 10 minutes . Hemodynamic support consisting of adrenaline 2mg/h + intermittent bolusses and dobutamine 6y do not stabilise the patient. BP stays around 60/40 and pulse is now at 45 bpm. Sat went up to 100% after intubation. At this stage intralipid ( lipid emulsion 20%) is given at a dose of 100ml iv direct and continued at 10 ml/ hour. Glucagon arrived from other hospitals at the same time and is also given at a dose of 5 mg iv. The patient slowly stabilises after rescue treatment and can be atmitted to ICU with BP 140/80 and pulse 70bpm. After 1 day adrenaline and dobutamine can be stopped and the patient is weaned from the ventilator. She left the hospital on day 4 without any neurological damage.
June 8, 2017 | Unregistered CommenterE.Verhoeven