Özet

48 yaşında erkek hasta acil servise şuur kaybı nedeniyle ailesi tarafından getirildi. Hastanın ailesinden alınan anamnezde doktor olduğu, kendisini muayenehanede baygın bir vaziyette buldukları ve yanında atenolol 50 mg ve verapamil 240 mg adlı ilaç kutularının boş olarak bulunduğunu tariflediler. Hasta intihar amaçlı ilaç zehirlenmesi olarak düşünüldü. Genel durumu kötü olan hasta entübe edildi ve kardiyopulmoner resüsitasyon başlandı. Hastaya geçici pil takıldı, sıvı ve inotropik destek sağlandı, glukagon başlandı. İlaçların etkisi ortadan kalkana kadar hayati organların perfüzyonunu sağlamak ve ilaçları vücuttan uzaklaştırmak amacıyla hasta ECMO (Ekstrakorporeal membran oksijenasyonu) cihazına bağlandı ayrıca hemofiltrasyon uygulandı. 48 saat işleme devam edildi ancak hastamızın hayati fonksiyonlarında iyileşme olmadı ve hasta kaybedildi. Beta bloker ve kalsiyum kanal blokerine bağlı intoksikasyon belirgin morbidite ve mortalite nedenidir. Bu yazıda intihar amaçlı aşırı dozda beta bloker ve kalsiyum kanal blokeri alan hastaya yaklaşım, komplikasyonlar, son tedavi şekilleri ve literatürlerin gözden geçirilmesini sunmaya çalıştık.
Anahtar Kelimeler: Beta Bloker, Kalsiyum kanal blokeri, İntoksikasyon

Beta Blocker and Calcium Channel Blocker Intoxication: Case Report and Review of the Literature

Summary

48-year-old male physician was presented to the emergency department because of unconsciousness. In his history, he was found in an unconscious state in his office and empty boxes of atenolol 50 mg and verapamil 240 mg spilled over. He was considered as a victim of beta blocker and calcium channel blocker intoxication due to attempt of suicide. On admission, he was cyanotic, his systolic blodd pressure was 50 mm Hg, heart rate was 30/min and he had shallow respiration. He was immediately resuscitated and intubated. A transvenous temporary pacemaker was implanted, he was supported with intravenous volume, inotropes and glucagon. Despite all efforts, he was hypotensive which was not enough for vital organ perfusion. Although he was supported with ECMO (Extracor - poreal membrane oxigenation) and hemofiltration, he died 48 hours later. Beta blocker and calcium channel blocker intoxication has high morbidity and mortality rates which is not uncommon. The primary aim in management of beta blocker and calcium channel blocker intoxication is to protect myocardial function and vital organ perfusion. For this purpose, numerous pharmocological and nonpharmacological treatment options should be used in a timely manner and often in a combined fashion. In this case report and review, we aimed to revise pathophysiology, clinical findings, complications and contemporary treatment approaches to beta blocker and calcium channel blocker intoxication.
Key Words: Beta blocker, Calcium channel blocker, İntoxication