Key result
IV lipid emulsion restores blood pressure and sinus rhythm in severe propranolol and ethanol overdose.
Why the study?
Severe propranolol overdose with atypical wide complex tachycardia is challenging to treat, and the role of intravenous lipid emulsion in this context is not well established.
Does intravenous lipid emulsion improve clinical outcomes in severe propranolol overdose with wide complex tachycardia?
Case Report (n=1)
Does intravenous lipid emulsion improve clinical outcomes in severe propranolol overdose with wide complex tachycardia?
Intravenous lipid emulsion may be an effective rescue therapy for severe propranolol toxicity presenting with refractory shock and wide complex tachycardia.
May support lipid emulsion rescue in refractory propranolol toxicity; leaves open need for controlled trials before practice change.
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.
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Jović-Stošić et al. (2011) conducted a case report in Severe propranolol and ethanol overdose (n=1). Intravenous lipid emulsion (20% Intralipid) was evaluated on Clinical improvement (blood pressure and sinus rhythm). Intravenous lipid emulsion successfully restored normal blood pressure and sinus rhythm in a patient with severe propranolol and ethanol overdose.
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