Glucagon is furthermore known to exert a positive inotropic and chronotropic effect on the myocardium by stimulating adenyl cyclase through a separate receptor to that of catecholamines. Numerous therapies have been advocated as useful in severe beta-blocker poisoning including volume expansion, atropine, calcium, cardiac pacing, infusion of inotropic and vasoactive medications, gastrointestinal decontamination, and charcoal hemodiafiltration. These unique features are thought to contribute to the increased mortality associated with propranolol intoxication when compared with poisoning from other beta-blocking agents. Propranolol is a lipophilic, nonselective, beta-blocker with additional sodium channel blocking activity. Reversal of bradycardia, negative inotropism, and restoration of critical organ perfusion are immediate goals of treatment. Accidental and intentional overdose may, however, result in intractable cardiovascular collapse.
Introductionīeta-adrenergic-blocking drugs are invaluable in treating a range of cardiovascular and noncardiovascular medical conditions. High dose insulin resulted in greater rate pressure product compared with lipid emulsion in this rabbit model of severe enteric/intravenous propranolol toxicity. No difference was observed in survival between groups (4/5 ING versus 2/5 ILE ).Ĭonclusions. A trend toward greater heart rate was observed in the ING group ( ).
Rate pressure product (RPP RPP = heart rate × mean arterial pressure) was greatest in the ING group at 60 minutes ( ). Animals were resuscitated with insulin at 3 U/kg plus 0.5 g/kg glucose (ING group), or 10 mL/kg 20% Intralipid (ILE group). At 30 minutes propranolol infusion was commenced at 4 mg/kg/hr and continued to a target mean arterial pressure (MAP) of 50% baseline MAP.
Sedated, mechanically ventilated and invasively monitored New Zealand White rabbits underwent mini-laparotomy and enterostomy formation with 40 mg/kg propranolol instilled into the proximal small bowel. We compare efficacy of the novel antidotes ING, with ILE, in a rabbit model of combined enteric/intravenous propranolol toxicity. High dose insulin/glucose (ING), and more recently intravenous lipid emulsion (ILE), have been proposed as potentially beneficial therapies in beta blocker intoxication. Beta-blocker overdose may result in intractable cardiovascular collapse despite conventional antidotal treatments.
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