Efficiency of Gastric Decontamination and Activated Charcoal in Beta Blocker (Metoprolol) Poisoning; A Case Report
Abstract
Beta blockers are negative inotrop and cronotrop in miyocardial activity. They are prescribed widely for multipl clinical conditions. Beta blocker overdose may ocur in patients who used it by accidently or for suicidal purposes. These drugs can effect cardiovascular functions as well as mental conditions. Many patients with overdose have fatal clinical conditions and require intensive treatment due to the drug effect.
Our case is a 33 year-old-woman, took 100 miligrams of metoprolol (2 blister of a pocket) 1 hour ago with the intention of committing suicide. She had nausea and vomiting, dizziness. Vital signs; her blood pressure was 120/70, heart rate was 85, respiratory rate and saturation were normal. Electrocardiogram was in sinus rtym and there was no change in the ST segment. She was placed under observation and closely monitored. We administered gastric decontamination to throw out the medications she took 1 hour ago. We administered her 1 liter salin and antiemetic medication to manage the nausea. After a while she had bradicardia and vomiting. We applied her a glucagon and atropin injection and she was admitted to the intensive care unit. After 2 hours, she was completely recover and had no clinical symptoms. She got monitorized for a day and was discharged from the hospital after full recovery. Since we know that the use of high doses of beta blockers is mortal and has poor clinical outcome, we think that the patient in this case underwent gastric decontamination and active charcoal early and succesfully, so she was discharged from the hospital with good clinical outcome.
As a result, it is thought that gastric decontamination and also active charcoal may be useful and lifesaving in case of drug overdose in early presentations.
References
- Love JN, Litovitz TL, Howell JM, Clancy C. Characterization of fatal beta blocker ingestion: a review of the American Association of Poison Control Centers data from 1985 to 1995. Journal of Toxicology: Clinical Toxicology. 1997;35(4):353-359.
- McLean M, Van Donselaar K, Thomas P, Tilney PV. A 42-year-old woman with a beta blocker overdose. Air Medical Journal. 2018;37(3):147-150.
- DeWitt CR, Waksman JC. Pharmacology, pathophysiology and management of calcium channel blocker and β-blocker toxicity. Toxicological reviews. 2004;23:223-238.
- Love JN, Love J, Howell JM, Litovitz TL, Klein-Schwartz W. Acute beta blocker overdose: factors associated with the development of cardiovascular morbidity. Journal of Toxicology: Clinical Toxicology. 2000;38(3):275-281.
- Konca C, Yildizdas RD, Sari MY, Yukselmis U, Horoz OO, Yılmaz HL. Evaluation of children poisoned with calcium channel blocker or beta blocker drugs. Turk Arch Ped. 2013;48:138-144.
- Goldfrank LR, Hoffman RS. Goldfrank's toxicologic emergencies. McGraw-Hill S. 2006. p. 896-906
- Kerns II W. Management of β-adrenergic blocker and calcium channel antagonist toxicity. Emergency medicine clinics of North America. 2007;25(2):309-331.
- Position paper: gastric lavage. American Academy of Clinical Toxicology, & European Association of Poisons Centres and Clinical Toxicologists. Journal of Toxicology: Clinical Toxicology. 2004;42(7):933-943.
- Rotella JA, Greene SL, Koutsogiannis Z, Graudins A, Hung Leang Y, Kuan K, Wong A. Treatment for beta-blocker poisoning: a systematic review. Clinical Toxicology. 2020;58(10): 943-983.
- Ajjampur K, Subramaniam A. The importance of early use of beta blockers and gastric decontamination in caffeine overdose: A case report. Australian Critical Care. 2021;34(4):
Beta Bloker (Metoprolol) Zehirlenmesinde Mide Dekontaminasyonu ve Aktif Kömürün Etkinliği; Bir Olgu Sunumu
Abstract
Beta blokerler miyokardiyal aktivitede negatif inotrop ve kronotroptur. Çoklu klinik durumlar için yaygın olarak reçete edilirler. Kazara veya intihar amacıyla kullanan hastalarda beta bloker doz aşımı ortaya çıkabilir. Bu ilaçlar kardiyovasküler fonksiyonların yanı sıra zihinsel durumları da etkileyebilir. Doz aşımı olan birçok hastada ilacın etkisi nedeniyle ölümcül klinik durumlar ortaya çıkmakta ve yoğun tedavi gerektirmektedir.
Olgumuz 33 yaşında kadın olup, intihar amacıyla 1 saat önce 100 miligram metoprolol (toplamda 2 blister) almıştır. Mide bulantısı ve kusması, baş dönmesi vardı. Vital bulguları; tansiyonu 120/70, nabzı 85, solunum sayısı ve saturasyonu normaldi. Elektrokardiyografi sinüs ritmindeydi ve ST segment değişikliği yoktu. Gözlem altına alındı ve yakından takip edildi. 1 saat önce aldığı ilaçları erken dönemde emilmesini engellemek için mide dekontaminasyonu yapıldı. Bulantısı için 1 litre salin ve antiemetik ilaç verildi. Bir süre sonra bradikardi ve kusması başlayan hastaya glukagon ve atropin enjeksiyonu yapıldı ve yoğun bakıma yatırıldı. 2 saat sonra tamamen iyileşen ve herhangi bir klinik semptomu kalmayan hasta bir gün gözetim altında tutuldu ve tamamen iyileştikten sonra hastaneden taburcu edildi. Yüksek dozda beta bloker kullanımının ölümcül olduğunu ve klinik sonucunun kötü olduğunu biliyoruz, bu olgudaki hastaya erken ve başarılı bir şekilde gastrik dekontaminasyon ve aktif kömür uygulandığı için klinik olarak iyi bir sonuçla taburcu edildiğini düşünmekteyiz.
Sonuç olarak erken başvurularda aşırı dozda ilaç alınması durumunda, mide dekontaminasyon ve aktif kömür uygulamasının faydalı ve hayat kurtarıcı olabileceği düşünülmektedir.
References
- Love JN, Litovitz TL, Howell JM, Clancy C. Characterization of fatal beta blocker ingestion: a review of the American Association of Poison Control Centers data from 1985 to 1995. Journal of Toxicology: Clinical Toxicology. 1997;35(4):353-359.
- McLean M, Van Donselaar K, Thomas P, Tilney PV. A 42-year-old woman with a beta blocker overdose. Air Medical Journal. 2018;37(3):147-150.
- DeWitt CR, Waksman JC. Pharmacology, pathophysiology and management of calcium channel blocker and β-blocker toxicity. Toxicological reviews. 2004;23:223-238.
- Love JN, Love J, Howell JM, Litovitz TL, Klein-Schwartz W. Acute beta blocker overdose: factors associated with the development of cardiovascular morbidity. Journal of Toxicology: Clinical Toxicology. 2000;38(3):275-281.
- Konca C, Yildizdas RD, Sari MY, Yukselmis U, Horoz OO, Yılmaz HL. Evaluation of children poisoned with calcium channel blocker or beta blocker drugs. Turk Arch Ped. 2013;48:138-144.
- Goldfrank LR, Hoffman RS. Goldfrank's toxicologic emergencies. McGraw-Hill S. 2006. p. 896-906
- Kerns II W. Management of β-adrenergic blocker and calcium channel antagonist toxicity. Emergency medicine clinics of North America. 2007;25(2):309-331.
- Position paper: gastric lavage. American Academy of Clinical Toxicology, & European Association of Poisons Centres and Clinical Toxicologists. Journal of Toxicology: Clinical Toxicology. 2004;42(7):933-943.
- Rotella JA, Greene SL, Koutsogiannis Z, Graudins A, Hung Leang Y, Kuan K, Wong A. Treatment for beta-blocker poisoning: a systematic review. Clinical Toxicology. 2020;58(10): 943-983.
- Ajjampur K, Subramaniam A. The importance of early use of beta blockers and gastric decontamination in caffeine overdose: A case report. Australian Critical Care. 2021;34(4):
Details
| Primary Language | English |
|---|---|
| Subjects | Health Services and Systems (Other) |
| Journal Section | Case Report / Case Series |
| Authors | |
| Publication Date | April 22, 2024 |
| Submission Date | February 29, 2024 |
| Acceptance Date | March 25, 2024 |
| Published in Issue | Year 2024 Volume: 4 Issue: 1 |
e-ISSN: 2791-9935