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Bradycardia and hypotension associated with fomepizole infusion during hemodialysis
We report a case of hypotension and bradycardia associated with intravenous fomepizole infusion. A 59-year-old man presented to hospital 10 hours after ethylene glycol ingestion with ataxia, slurred speech, metabolic acidosis, heart rate 70/min, blood pressure 160/100 mmHg. Treatment with hemodialys...
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| Published in: | Clinical toxicology (Philadelphia, Pa.) Pa.), 2008-07, Vol.46 (6), p.570-573 |
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| cited_by | cdi_FETCH-LOGICAL-c486t-4b1f37f4d7dae8bc171e6e56fa1ba4f9cc48a88c6b92ac98bf018dbd3cf879e33 |
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| cites | cdi_FETCH-LOGICAL-c486t-4b1f37f4d7dae8bc171e6e56fa1ba4f9cc48a88c6b92ac98bf018dbd3cf879e33 |
| container_end_page | 573 |
| container_issue | 6 |
| container_start_page | 570 |
| container_title | Clinical toxicology (Philadelphia, Pa.) |
| container_volume | 46 |
| creator | LEPIK, Katherine J BRUBACHER, Jeffrey R DEWITT, Christopher R LAM, George S. S LAWSON, Edward J ERHARDT, Gunnar D PURSSELL, Roy A KENNEDY, James R BRIGNALL, Jane L |
| description | We report a case of hypotension and bradycardia associated with intravenous fomepizole infusion.
A 59-year-old man presented to hospital 10 hours after ethylene glycol ingestion with ataxia, slurred speech, metabolic acidosis, heart rate 70/min, blood pressure 160/100 mmHg. Treatment with hemodialysis and fomepizole began 7.5 hours after admission. Severe bradycardia (29/min) and hypotension (69 mmHg systolic) occurred immediately following a 30 minute intravenous infusion of the first (19 mg/kg) fomepizole dose, but rapidly corrected with 1 mg atropine. Transient bradycardia (48/min) and hypotension (89/57 mmHg) recurred immediately after the second (10 mg/kg) fomepizole dose, also given during dialysis.
Hemodialysis may cause a drop in blood pressure and heart rate; however, the close temporal relationship with fomepizole infusions, dose-related symptom intensity and recurrence with rechallenge suggest a causal relationship with fomepizole. Hemodialysis, acidosis and high initial fomepizole dose may have enhanced patient susceptibility, as a post-dialysis fomepizole dose was well tolerated.
Fomepizole may precipitate bradycardia and/or hypotension during hemodialysis. Monitor vital signs closely during and immediately after infusion. |
| doi_str_mv | 10.1080/15563650701725128 |
| format | article |
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A 59-year-old man presented to hospital 10 hours after ethylene glycol ingestion with ataxia, slurred speech, metabolic acidosis, heart rate 70/min, blood pressure 160/100 mmHg. Treatment with hemodialysis and fomepizole began 7.5 hours after admission. Severe bradycardia (29/min) and hypotension (69 mmHg systolic) occurred immediately following a 30 minute intravenous infusion of the first (19 mg/kg) fomepizole dose, but rapidly corrected with 1 mg atropine. Transient bradycardia (48/min) and hypotension (89/57 mmHg) recurred immediately after the second (10 mg/kg) fomepizole dose, also given during dialysis.
Hemodialysis may cause a drop in blood pressure and heart rate; however, the close temporal relationship with fomepizole infusions, dose-related symptom intensity and recurrence with rechallenge suggest a causal relationship with fomepizole. Hemodialysis, acidosis and high initial fomepizole dose may have enhanced patient susceptibility, as a post-dialysis fomepizole dose was well tolerated.
Fomepizole may precipitate bradycardia and/or hypotension during hemodialysis. Monitor vital signs closely during and immediately after infusion.</description><identifier>ISSN: 1556-3650</identifier><identifier>EISSN: 1556-9519</identifier><identifier>DOI: 10.1080/15563650701725128</identifier><identifier>PMID: 18584373</identifier><language>eng</language><publisher>Philadelphia, PA: Taylor & Francis</publisher><subject>Acidosis - complications ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Antidotes - administration & dosage ; Antidotes - adverse effects ; Antidotes - therapeutic use ; Biological and medical sciences ; Blood Pressure - drug effects ; Bradycardia - chemically induced ; Cardiac dysrhythmias ; Cardiology. Vascular system ; Chemical and industrial products toxicology. Toxic occupational diseases ; Dose-Response Relationship, Drug ; Emergency and intensive care: renal failure. Dialysis management ; Ethylene Glycol - poisoning ; Heart ; Heart Rate - drug effects ; Humans ; Hypotension - chemically induced ; Infusions, Intravenous ; Intensive care medicine ; Male ; Medical sciences ; Middle Aged ; Pyrazoles - administration & dosage ; Pyrazoles - adverse effects ; Pyrazoles - therapeutic use ; Renal Dialysis ; Solvents ; Toxicology</subject><ispartof>Clinical toxicology (Philadelphia, Pa.), 2008-07, Vol.46 (6), p.570-573</ispartof><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c486t-4b1f37f4d7dae8bc171e6e56fa1ba4f9cc48a88c6b92ac98bf018dbd3cf879e33</citedby><cites>FETCH-LOGICAL-c486t-4b1f37f4d7dae8bc171e6e56fa1ba4f9cc48a88c6b92ac98bf018dbd3cf879e33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20519984$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18584373$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>LEPIK, Katherine J</creatorcontrib><creatorcontrib>BRUBACHER, Jeffrey R</creatorcontrib><creatorcontrib>DEWITT, Christopher R</creatorcontrib><creatorcontrib>LAM, George S. S</creatorcontrib><creatorcontrib>LAWSON, Edward J</creatorcontrib><creatorcontrib>ERHARDT, Gunnar D</creatorcontrib><creatorcontrib>PURSSELL, Roy A</creatorcontrib><creatorcontrib>KENNEDY, James R</creatorcontrib><creatorcontrib>BRIGNALL, Jane L</creatorcontrib><title>Bradycardia and hypotension associated with fomepizole infusion during hemodialysis</title><title>Clinical toxicology (Philadelphia, Pa.)</title><addtitle>Clin Toxicol (Phila)</addtitle><description>We report a case of hypotension and bradycardia associated with intravenous fomepizole infusion.
A 59-year-old man presented to hospital 10 hours after ethylene glycol ingestion with ataxia, slurred speech, metabolic acidosis, heart rate 70/min, blood pressure 160/100 mmHg. Treatment with hemodialysis and fomepizole began 7.5 hours after admission. Severe bradycardia (29/min) and hypotension (69 mmHg systolic) occurred immediately following a 30 minute intravenous infusion of the first (19 mg/kg) fomepizole dose, but rapidly corrected with 1 mg atropine. Transient bradycardia (48/min) and hypotension (89/57 mmHg) recurred immediately after the second (10 mg/kg) fomepizole dose, also given during dialysis.
Hemodialysis may cause a drop in blood pressure and heart rate; however, the close temporal relationship with fomepizole infusions, dose-related symptom intensity and recurrence with rechallenge suggest a causal relationship with fomepizole. Hemodialysis, acidosis and high initial fomepizole dose may have enhanced patient susceptibility, as a post-dialysis fomepizole dose was well tolerated.
Fomepizole may precipitate bradycardia and/or hypotension during hemodialysis. Monitor vital signs closely during and immediately after infusion.</description><subject>Acidosis - complications</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Antidotes - administration & dosage</subject><subject>Antidotes - adverse effects</subject><subject>Antidotes - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Blood Pressure - drug effects</subject><subject>Bradycardia - chemically induced</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology. Vascular system</subject><subject>Chemical and industrial products toxicology. Toxic occupational diseases</subject><subject>Dose-Response Relationship, Drug</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Ethylene Glycol - poisoning</subject><subject>Heart</subject><subject>Heart Rate - drug effects</subject><subject>Humans</subject><subject>Hypotension - chemically induced</subject><subject>Infusions, Intravenous</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pyrazoles - administration & dosage</subject><subject>Pyrazoles - adverse effects</subject><subject>Pyrazoles - therapeutic use</subject><subject>Renal Dialysis</subject><subject>Solvents</subject><subject>Toxicology</subject><issn>1556-3650</issn><issn>1556-9519</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><recordid>eNqN0T1PwzAQBmALgWgp_AAWlAW2gC9OYmeEii-pEgMwRxd_UKMkLnYiFH49KUQwsDCddXruHV4Tcgz0HKigF5BlOcszyinwJINE7JD5dhcXGRS703sLZuQghFdKmUgL2CczEJlIGWdz8njlUQ0SvbIYYaui9bBxnW6DdW2EIThpsdMqerfdOjKu0Rv74Wod2db0X0b13rYv0Vo3boyoh2DDIdkzWAd9NM0Feb65flrexauH2_vl5SqWqci7OK3AMG5SxRVqUUngoHOd5QahwtQUcmQohMyrIkFZiMpQEKpSTBrBC83Ygpx95268e-t16MrGBqnrGlvt-lAmNM84CP4PCJAwno8QvqH0LgSvTbnxtkE_lEDLbeXln8rHm5MpvK8arX4vpo5HcDoBDBJr47GVNvy4hI6fVYz0E0WWitc</recordid><startdate>200807</startdate><enddate>200807</enddate><creator>LEPIK, Katherine J</creator><creator>BRUBACHER, Jeffrey R</creator><creator>DEWITT, Christopher R</creator><creator>LAM, George S. S</creator><creator>LAWSON, Edward J</creator><creator>ERHARDT, Gunnar D</creator><creator>PURSSELL, Roy A</creator><creator>KENNEDY, James R</creator><creator>BRIGNALL, Jane L</creator><general>Taylor & Francis</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U7</scope><scope>C1K</scope><scope>7ST</scope><scope>SOI</scope></search><sort><creationdate>200807</creationdate><title>Bradycardia and hypotension associated with fomepizole infusion during hemodialysis</title><author>LEPIK, Katherine J ; BRUBACHER, Jeffrey R ; DEWITT, Christopher R ; LAM, George S. 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Toxic occupational diseases</topic><topic>Dose-Response Relationship, Drug</topic><topic>Emergency and intensive care: renal failure. Dialysis management</topic><topic>Ethylene Glycol - poisoning</topic><topic>Heart</topic><topic>Heart Rate - drug effects</topic><topic>Humans</topic><topic>Hypotension - chemically induced</topic><topic>Infusions, Intravenous</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pyrazoles - administration & dosage</topic><topic>Pyrazoles - adverse effects</topic><topic>Pyrazoles - therapeutic use</topic><topic>Renal Dialysis</topic><topic>Solvents</topic><topic>Toxicology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>LEPIK, Katherine J</creatorcontrib><creatorcontrib>BRUBACHER, Jeffrey R</creatorcontrib><creatorcontrib>DEWITT, Christopher R</creatorcontrib><creatorcontrib>LAM, George S. S</creatorcontrib><creatorcontrib>LAWSON, Edward J</creatorcontrib><creatorcontrib>ERHARDT, Gunnar D</creatorcontrib><creatorcontrib>PURSSELL, Roy A</creatorcontrib><creatorcontrib>KENNEDY, James R</creatorcontrib><creatorcontrib>BRIGNALL, Jane L</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Environment Abstracts</collection><collection>Environment Abstracts</collection><jtitle>Clinical toxicology (Philadelphia, Pa.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>LEPIK, Katherine J</au><au>BRUBACHER, Jeffrey R</au><au>DEWITT, Christopher R</au><au>LAM, George S. S</au><au>LAWSON, Edward J</au><au>ERHARDT, Gunnar D</au><au>PURSSELL, Roy A</au><au>KENNEDY, James R</au><au>BRIGNALL, Jane L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bradycardia and hypotension associated with fomepizole infusion during hemodialysis</atitle><jtitle>Clinical toxicology (Philadelphia, Pa.)</jtitle><addtitle>Clin Toxicol (Phila)</addtitle><date>2008-07</date><risdate>2008</risdate><volume>46</volume><issue>6</issue><spage>570</spage><epage>573</epage><pages>570-573</pages><issn>1556-3650</issn><eissn>1556-9519</eissn><abstract>We report a case of hypotension and bradycardia associated with intravenous fomepizole infusion.
A 59-year-old man presented to hospital 10 hours after ethylene glycol ingestion with ataxia, slurred speech, metabolic acidosis, heart rate 70/min, blood pressure 160/100 mmHg. Treatment with hemodialysis and fomepizole began 7.5 hours after admission. Severe bradycardia (29/min) and hypotension (69 mmHg systolic) occurred immediately following a 30 minute intravenous infusion of the first (19 mg/kg) fomepizole dose, but rapidly corrected with 1 mg atropine. Transient bradycardia (48/min) and hypotension (89/57 mmHg) recurred immediately after the second (10 mg/kg) fomepizole dose, also given during dialysis.
Hemodialysis may cause a drop in blood pressure and heart rate; however, the close temporal relationship with fomepizole infusions, dose-related symptom intensity and recurrence with rechallenge suggest a causal relationship with fomepizole. Hemodialysis, acidosis and high initial fomepizole dose may have enhanced patient susceptibility, as a post-dialysis fomepizole dose was well tolerated.
Fomepizole may precipitate bradycardia and/or hypotension during hemodialysis. Monitor vital signs closely during and immediately after infusion.</abstract><cop>Philadelphia, PA</cop><pub>Taylor & Francis</pub><pmid>18584373</pmid><doi>10.1080/15563650701725128</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1556-3650 |
| ispartof | Clinical toxicology (Philadelphia, Pa.), 2008-07, Vol.46 (6), p.570-573 |
| issn | 1556-3650 1556-9519 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_20657187 |
| source | Taylor and Francis:Jisc Collections:Taylor and Francis Read and Publish Agreement 2024-2025:Medical Collection (Reading list) |
| subjects | Acidosis - complications Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Antidotes - administration & dosage Antidotes - adverse effects Antidotes - therapeutic use Biological and medical sciences Blood Pressure - drug effects Bradycardia - chemically induced Cardiac dysrhythmias Cardiology. Vascular system Chemical and industrial products toxicology. Toxic occupational diseases Dose-Response Relationship, Drug Emergency and intensive care: renal failure. Dialysis management Ethylene Glycol - poisoning Heart Heart Rate - drug effects Humans Hypotension - chemically induced Infusions, Intravenous Intensive care medicine Male Medical sciences Middle Aged Pyrazoles - administration & dosage Pyrazoles - adverse effects Pyrazoles - therapeutic use Renal Dialysis Solvents Toxicology |
| title | Bradycardia and hypotension associated with fomepizole infusion during hemodialysis |
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