ABSTRACT
La intoxicación por bloqueadores de los canales de calcio puede dar lugar a un cuadro extremadamente grave. Presentamos el caso de un paciente con intoxicación severa por diltiazemque desarrolló un profundo estado de shock y disfunción multiorgánica. La inestabilidad hemodinámica puede serrefractaria a las medidas terapéuticas habituales, requiriendo la implementación de tratamientos coadyuvantes para sostener las funciones vitales. Analizamos la presentación clínica y fisiopatología de la intoxicación por calcio antagonistas.Finalmente, presentamos las alternativas terapéuticas en base a la evidencia actual.
Calcium channel blockers poisoning can result in a severe condition. The study presents the case of a patient suffering from severe poisoning caused by diltiazem who developed a deep shock and multiple organ dysfunction. Hemodynamics instability may be refractory to the usual therapeutic measures, requiring the implementationof adjuvant therapy to support vital functions. The study examines the clinical presentation and pathophysiology of calcium channel blockers. Last, the therapeutic alternatives are presented based on current evidence.
A intoxicação por bloqueadores dos canais de cálcio pode causar um quadro extremadamente grave. Apresentamos o caso de um paciente com intoxicação severapor diltiazem que evoluiu a estado de choque profundo e disfunção multiorgânica. A instabilidade hemodinâmica pode ser refratária às medidas terapêuticas habituais,sendo necessário implementar tratamentos coadjuvantes para manter as funções vitais. Analisamos aapresentação clínica e a fisiopatologia da intoxicação por cálcio antagonistas. Finalmente, apresentamos asalternativas terapêuticas considerando as evidencias disponíveis atualmente.
Subject(s)
Calcium Channel Blockers/toxicity , Case ReportsABSTRACT
INTRODUCTION: Chronic airflow obstruction in conditions such as chronic obstructive pulmonary disease is associated with respiratory muscle dysfunction. Our aim was to study the effects of salbutamol-a beta-adrenergic agonist known to improve muscle strength in physiologic and pathologic conditions-on diaphragm contractility in an animal model of chronic airway obstruction achieved by tracheal banding. MATERIALS AND METHODS: Twenty-four Sprague-Dawley rats were randomized into a control group and 3 tracheal banding groups, 1 that received acute salbutamol treatment, 1 that received chronic salbutamol treatment, and 1 that received nothing. Arterial blood gases, acid-base balance, and in vitro diaphragmatic contractility were evaluated by measuring peak twitch tension, contraction time, contraction velocity, half-relaxation time, relaxation velocity, and force-frequency curves. RESULTS: The 3 study groups had significantly reduced arterial pH and increased PaCO2 and bicarbonate levels compared to the control group (P<.05). The untreated tracheal banding group had significantly reduced peak twitch tension and contraction velocity, and a significantly lower force-frequency curve in comparison with the other groups (P<.05). The chronic treatment group had a higher relaxation velocity than the untreated study group (P<.05). The mean (SE) peak twitch tension values were 6.46 (0.90)N/cm(2) for the control group, 3.28 (0.55)N/cm(2) for the untreated tracheal banding group, 6.18 (0.71)N/cm(2) for the acute treatment group, and 7.09 (0.59)N/cm(2) for the chronic treatment group. CONCLUSIONS: Diaphragmatic dysfunction associated with chronic airflow obstruction improves with both the acute and chronic administration of salbutamol. The mechanisms involved in respiratory muscle dysfunction warrant further study.