Severe propranolol and ethanol overdose with wide complex tachycardia treated with intravenous lipid emulsion: A case report

Background. Propranolol is a highly lipid-soluble beta-blocker. We describe a case of severe propranolol overdose, with atypical dysrhythmia - wide complex tachycardia - which was successfully treated with lipid emulsion. Case report. A 31-year-old woman ingested approximately 3.6 g of propranolol a...

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Bibliographic Details
Published in:Clinical toxicology (Philadelphia, Pa.) Pa.), 2011-06, Vol.49 (5), p.426-430
Main Authors: Jovic-Stosic, Jasmina, Gligic, Branko, Putic, Vesna, Brajkovic, Gordana, Spasic, Radenko
Format: Article
Language:English
Subjects:
Adrenergic beta-Antagonists - poisoning
Adult
Drug Overdose
Electrocardiography
Ethanol - poisoning
Fat Emulsions, Intravenous - therapeutic use
Female
Humans
Propranolol - poisoning
Tachycardia - chemically induced
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Summary:Background. Propranolol is a highly lipid-soluble beta-blocker. We describe a case of severe propranolol overdose, with atypical dysrhythmia - wide complex tachycardia - which was successfully treated with lipid emulsion. Case report. A 31-year-old woman ingested approximately 3.6 g of propranolol along with ethanol. Clinical manifestations of poisoning included coma, seizures, respiratory failure, hypoglycaemia, circulatory shock, and dysrhythmias. An ECG revealed nonspecific intraventricular conduction delay, followed by wide complex supraventricular tachycardia. Toxicological analysis of blood showed ethanol 2.42 g/L and propranolol 4.21 mg/L. The patient responded poorly to conventional therapy, so intravenous lipid emulsion was used. Apart from IV dopamine, the only treatment after the onset of wide complex tachycardia was 20% Intralipid. Transient improvement was noticed after the initial dose of 500 mL; during the infusion of further Intralipid, blood pressure returned to normal and sinus rhythm was re-established. Conclusion. We believe that lipid emulsion had a beneficial effect in the treatment of propranolol toxicity.
ISSN:1556-3650
1556-9519
DOI:10.3109/15563650.2011.583251