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首页> 外文期刊>Clinical toxicology: the official journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists >Loperamide induced cardiac arrhythmia successfully supported with veno-arterial ECMO (VA-ECMO), molecular adsorbent recirculating system (MARS) and continuous renal replacement therapy (CRRT)
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Loperamide induced cardiac arrhythmia successfully supported with veno-arterial ECMO (VA-ECMO), molecular adsorbent recirculating system (MARS) and continuous renal replacement therapy (CRRT)

机译：Loperamide诱导心性心律失常成功支持静脉动脉Ecmo（VA-ECMO），分子吸附剂再循环系统（MARS）和连续肾置换疗法（CRRT）

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Introduction: This case of Loperamide misuse had refractory ventricular arrhythmias and was successfully supported by VA ECMO. Loperamide is currently available without prescription and can be obtained in large quantities over the internet despite Food and Drug Administration (FDA) 2016 black box warning noting cardiac toxicity. This case illustrates the life-threatening toxicity of loperamide and suggests a supportive modality to provide clinical time while the drug is cleared endogenously or exogenously. Case report: A 36-year-old female was found minimally responsive. Vital signs and monitoring revealed wide complex bradycardia, undetectable blood pressure, hypothermia, bradypnea, and hypoglycemia. The rhythm degenerated to polymorphic ventricular tachycardia cardia refractory to multiple ACLS protocols. VA-ECMO was initiated with immediate stabilization. Subsequent history revealed massive consumption of loperamide taking 400-600 mg daily. Highest known loperamide and N-desmethyl-loperamide levels were 32 and 500 ng/ml respectively. Since loperamide and metabolites are known to be protein bound, molecular adsorbent recirculating system (MARS) was initiated for toxin clearance. Additionally, she developed acute renal failure supported by CRRT. She was ultimately weaned from ECMO, MARS, and CRRT and discharged neurologically intact on hospital day 12. Discussion: VA ECMO for hemodynamic support provided the needed time for natural resolution of the cardiac toxicity while providing adequate perfusion. MARS was used in the setting of highly protein bound toxins, but drug clearance could not be demonstrated through serial levels. VA ECMO (or referral to a center with VA ECMO) should be considered with lethal loperamide-induced cardiotoxicity and perhaps other cardio-toxins.
机译：介绍：这种杀菌的这种情况滥用具有难治性室性心律失常，并由VA ECMO成功支持。目前没有处方的Loperamide可以在互联网上大量获得，尽管食品和药物管理局（FDA）2016年黑匣子警告注意心脏毒性。这种情况说明了罗伯拉胺的威胁性毒性，并提出了在内源或外源清除药物时提供临床时间的支持性模态。案例报告：一名36岁的女性被发现最敏感。生命体征和监测揭示了宽复杂的心动过速，不可检测的血压，低温，体温过低，细胞瘤和低血糖。节奏已退化为多晶型心动过卡型Cardia难以进行多种ACLS方案。 VA-ECMO是立即稳定的。随后的历史表明，每天服用400-600毫克的洛哌米胺大量消耗。最高已知的罗伯拉胺和N-去甲基 - 洛哌酰胺水平分别为32和500ng / mL。由于已知洛哌酰胺和代谢物是蛋白质结合的，因此开始用于毒素清除的分子吸附剂再循环系统（MARS）。此外，她开发了CRRT支持的急性肾功能衰竭。她最终从Ecmo，火星和CRRT和CRRT断奶，并在医院第12天出院。讨论：血液动力学支持的VA ECMO为心脏毒性的自然分辨率提供了所需的时间，同时提供足够的灌注。在高度蛋白质结合毒素的设置中使用火星，但不能通过连续水平证明药物清除。应考虑VA ECMO（或与VA ECMO的中心转诊）与致死的洛哌胺诱导的心脏毒性，也许是其他有氧毒素。

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