[Antiadrenergic rescue therapy with amiodarone in children with severe left ventricular dysfunction secondary to scorpion envenomation]. / Terapia de resgate com amiodarona em crianças com grave disfunção ventricular esquerda causada por veneno de escorpião.
Arq Bras Cardiol
; 94(1): 18-24, 2010 Jan.
Article
en Pt
| MEDLINE
| ID: mdl-20414522
ABSTRACT
BACKGROUND:
Children with scorpion envenomation have massive sympathetic activation and variable degrees of left ventricular systolic dysfunction.OBJECTIVE:
To evaluate a rescue protocol for children with severe left ventricular dysfunction secondary to scorpion envenomation.METHODS:
Four children, after scorpion envenomation, were subjected to a rescue protocol for acute left ventricular dysfunction Endotracheal intubation and respiratory assistance, electrocardiograms, chest x-Ray, echocardiograms and blood samples for norepinephrine and troponin I serum levels. Samples and echocardiograms were repeated at 12, 24 and 48 hours. Intravenous medications Dobutamine 4-6 microg/kg/min. Amiodarone 3 mg/kg during a 2 hour period. Maintenance 5 mg/kg/day. Furosemide 0.5 mg/kg/dose. Diuretics were given when the systemic blood pressure was above percentile fifty. Amiodarone, Dobutamine and Furosemide were administered during the first 48 hours. Beta-adrenergic blockers and angiotensin converting enzyme were given, at 48 hours after admission, once the left ventricular Ejection fraction > 0.35 and the clinical status had improved.RESULTS:
On admission, norepinephrine was 1,727.50 +/-794.96 pg/ml, troponin I 24.53 +/- 14.09 ng/ml and left ventricular ejection fraction 0.20 +/- 0.056. At twelve hours, norepinephrine and troponin I serum levels were down to half of the initial values and the ejection fraction increased to 0.32 +/- 0.059. During the next 24 and 48 hours, the ejection fraction rose to 0.46 +/- 0.045, (p<0.01) and norepinephrine and troponin diminished to 526.75 +/- 273.73 (p < 0.02) and 2.20 +/- 2.36 (p<0.02) respectively.CONCLUSION:
Amiodarone, by acting as a neuromodulator, is very likely responsible for the early and progressive decrease of serum norepinephrine.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Venenos de Escorpión
/
Disfunción Ventricular Izquierda
/
Antagonistas Adrenérgicos
/
Amiodarona
Tipo de estudio:
Guideline
Límite:
Adolescent
/
Child
/
Child, preschool
/
Female
/
Humans
/
Male
Idioma:
Pt
Revista:
Arq Bras Cardiol
Año:
2010
Tipo del documento:
Article
País de afiliación:
Venezuela