静脉内脂肪乳剂(ILE)的给药是一种行之有效的解毒剂,可用于逆转局部麻醉药相关的全身毒性。尽管先前已经证明了ILE产生亲脂性药物的血液组织分配的能力,关于将其用作其他亲脂性药物的解毒剂的明确建议仍在辩论中。文拉法辛(一种抗抑郁药,用作5-羟色胺-去甲肾上腺素再摄取抑制剂(SNRI))和喹硫平(第二代非典型抗精神病药)广泛用于治疗精神病。两者都是已知诱导心脏毒性和中枢神经抑制的亲脂性药物。我们报告了一名33岁的有分裂情感障碍病史的男子,该男子因自愿摄入12g喹硫平和4.5g文拉法辛而失去知觉后被送往急诊科(ED)。初步评估显示,患者心肺功能稳定,但GCS为4(M2E1V1)无反应。在ED中,他被插管,并进行洗胃。入住重症监护病房(ICU)后,他的病情迅速恶化,发展为晶体和血管升压药输注难治性心血管塌陷。发生了交界性心动过缓,随后自发转换为窦性心律。随后,频发室性早搏,以及bigeminy的模式,三位一体,甚至出现非持续性室性心动过速,发生了。此外,观察到全身性强直-阵挛性癫痫发作。除了支持治疗,抗心律失常和抗惊厥治疗,静脉内脂肪乳剂推注,并连续输注。在接下来的几个小时里,他的病情逐渐好转,24小时后,他逐渐减少了血管升压药。在第2天,患者重复心血管崩溃,并施用第二剂量的ILE。在接下来的几天里,患者的临床状况有所改善,他成功地摆脱了呼吸机和血管加压药的支持。在严重的亲脂性药物中毒的情况下,ILE有可能成为一种抢救疗法,并且应被视为对支持疗法难以治疗的严重心血管不稳定的可行治疗方法。
The administration of intravenous lipid emulsion (ILE) is a proven
antidote used to reverse local anesthetic-related systemic toxicity. Although the capacity of ILE to generate blood tissue partitioning of lipophilic drugs has been previously demonstrated, a clear recommendation for its use as an
antidote for other lipophilic drugs is still under debate. Venlafaxine (an antidepressant acting as a serotonin-norepinephrine reuptake inhibitor (SNRI)) and quetiapine (a second-generation atypical antipsychotic) are widely used in the treatment of psychotic disorders. Both are lipophilic drugs known to induce cardiotoxicity and central nervous depression. We report the
case of a 33-year-old man with a medical history of schizoaffective disorder who was admitted to the emergency department (ED) after having been found unconscious due to a voluntary ingestion of 12 g of quetiapine and 4.5 g of venlafaxine. Initial assessment revealed a cardiorespiratory stable patient but unresponsive with a GCS of 4 (M2 E1 V1). In the ED, he was intubated, and gastric lavage was performed. Immediately after the admission to the intensive care unit (ICU), his condition quickly deteriorated, developing cardiovascular collapse refractory to crystalloids and vasopressor infusion. Junctional bradycardia occurred, followed by spontaneous conversion to sinus rhythm. Subsequently, frequent ventricular extrasystoles, as well as patterns of bigeminy, trigeminy, and even episodes of non-sustained ventricular tachycardia, occurred. Additionally, generalized tonic-clonic seizures were observed. Alongside supportive therapy, antiarrhythmic and anticonvulsant therapy, intravenous lipid emulsion bolus, and continuous infusion were administered. His condition progressively improved over the following hours, and 24 h later, he was tapered off the vasopressor. On day 2, the patient repeated the cardiovascular collapse and a second dose of ILE was administered. Over the next few days, the patient\'s clinical condition improved, and he was successfully weaned off ventilator and vasopressor support. ILE has the potential to become a form of rescue therapy in cases of severe lipophilic drug poisoning and should be considered a viable treatment for severe cardiovascular instability that is refractory to supportive therapy.