Annals of Emergency Medicine
Volume 51, Issue 4 , Pages 412-415.e1 , April 2008

Use of Lipid Emulsion in the Resuscitation of a Patient With Prolonged Cardiovascular Collapse After Overdose of Bupropion and Lamotrigine

  • Archie J. Sirianni, MD

      Affiliations

    • Department of Anesthesiology, Riddle Memorial Hospital, Media, PA
    • ,
  • Kevin C. Osterhoudt, MD

      Affiliations

    • Department of Pediatrics, University of Pennsylvania School of Medicine and The Children’s Hospital of Philadelphia, Philadelphia, PA
    • Section of Clinical Toxicology, Division of Emergency Medicine, and the Poison Control Center, The Children’s Hospital of Philadelphia, Philadelphia, PA
    • ,
  • Diane P. Calello, MD

      Affiliations

    • Department of Pediatrics, University of Pennsylvania School of Medicine and The Children’s Hospital of Philadelphia, Philadelphia, PA
    • Section of Clinical Toxicology, Division of Emergency Medicine, and the Poison Control Center, The Children’s Hospital of Philadelphia, Philadelphia, PA
    • ,
  • Allison A. Muller, PharmD

      Affiliations

    • Department of Pediatrics, University of Pennsylvania School of Medicine and The Children’s Hospital of Philadelphia, Philadelphia, PA
    • Section of Clinical Toxicology, Division of Emergency Medicine, and the Poison Control Center, The Children’s Hospital of Philadelphia, Philadelphia, PA
    • ,
  • Marie R. Waterhouse, MD

      Affiliations

    • Department of Pediatrics, University of Pennsylvania School of Medicine and The Children’s Hospital of Philadelphia, Philadelphia, PA
    • ,
  • Michael B. Goodkin, MD

      Affiliations

    • Division of Cardiology, Riddle Memorial Hospital, Media, PA
    • ,
  • Guy L. Weinberg, MD

      Affiliations

    • Department of Anesthesiology, University of Illinois College of Medicine at Chicago, and Jessie Brown VA Medical Center, Chicago, IL.
    • ,
  • Fred M. Henretig, MD

      Affiliations

    • Department of Pediatrics, University of Pennsylvania School of Medicine and The Children’s Hospital of Philadelphia, Philadelphia, PA
    • Section of Clinical Toxicology, Division of Emergency Medicine, and the Poison Control Center, The Children’s Hospital of Philadelphia, Philadelphia, PA
    • Corresponding Author InformationAddress for correspondence: Fred M. Henretig, MD, Division of Emergency Medicine, The Children’s Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA 19104; 215-590-4713, fax 215-590-4419

Received 30 April 2007 ,Revised 31 May 2007 ,Accepted 8 June 2007.

References 

  1. American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiac care: toxicology in ECC. Circulation. 2005;112:IV126–IV132
  2. Schwartz DR, Kaufman B. Local anesthetics. In:  Flomenbaum NE,  Goldfrank LR,  Hoffman RS, et al. editor. Goldfrank’s Toxicologic Emergencies. 8th ed.. New York, NY: McGraw-Hill; 2006;p. 1004–1015
  3. Weinberg G. Lipid rescue resuscitation from local anesthetic cardiac toxicity. Toxicol Rev. 2006;25:139–145
  4. Weinberg G, Vadeboncouer T, Ramaraju GA, et al. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology. 1998;88:1071–1075
  5. Weinberg G, Ripper R, Feinstein DL, et al. Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity. Reg Anesth Pain Med. 2003;28:198–202
  6. Harvey M, Cave G. Intralipid outperforms sodium bicarbonate in a rabbit model of clomipramine toxicity. Ann Emerg Med. 2007;49:178–185
  7. Bania TC, Chu J, Perez E, et al. Hemodynamic effects of intravenous fat emulsion in an animal model of severe verapamil toxicity resuscitated with atropine, calcium and saline. Acad Emerg Med. 2007;14:105–111
  8. Rosenblatt MA, Abel M, Fischer G, et al. Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine related cardiac arrest. Anesthesiology. 2006;105:217–218
  9. Litz RJ, Popp M, Stehr SN, et al. Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion. Anaesthesia. 2006;61:800–801
  10. Curry SC, Kashani JS, LoVecchio F, et al. Intraventricular conduction delay after bupropion overdose. J Emerg Med. 2005;29:299–305
  11. Harris CR, Gualtieri J, Stark G. Fatal bupropion overdose. J Toxicol Clin Toxicol. 1997;25:321–324
  12. Gursahani K, Tobias JD. Fatal cardiac dysrhythmia following a bupropion overdose in an adolescent. J Int Care Med. 2002;17:136–138
  13. Seger DL. Anticonvulsant medications. In:  Dart RC editors. Medical Toxicology. 3rd ed.. Philadelphia, PA: Lippincott Williams & Wilkins; 2004;p. 789–804
  14. Delgado JN, Gisvold O, Remers WA. Calculated log P, log D, and pKa. [appendix] In:  Delgado JN,  Gisvold O,  Remers WA editor. Gisvold’s Textbook of Organic, Medicinal and Pharmaceutical Chemistry. Philadelphia, PA: Lippincott Williams & Wilkins; 1998;p. 948–956
  15. Intralipid 20%. Deerfield, IL: Baxter Healthcare Corporation; 2000;[package insert]

 Supervising editors: Lewis S. Nelson, MD; G. Randall Bond, MDFunding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Since acceptance of the paper, GW was awarded US patent 7,261,903 B1, “Lipid emulsion in the treatment of systemic poisoning.” GW has no equity interest or financial agreements with any company or commercial entity related to this method and has never received salary or support from any company related to the method. GW does not intend to prohibit or restrict the practice of this method on any patient. GW and FH also co-authored a response to a letter to the editor, publishing in this issue.Publication dates: Available online September 4, 2007.Reprints not available from the authors.

PII: S0196-0644(07)00717-2

doi: 10.1016/j.annemergmed.2007.06.004

Annals of Emergency Medicine
Volume 51, Issue 4 , Pages 412-415.e1 , April 2008

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