RESUMEN
A couple of days after increasing the dosage of betaadrenergic- and adding calcium channel blockers due to an increased heart rate in atrial fibrillation, a 77 year old female was found in cardiogenic shock. After exclusion of further causes a therapy with catecholamines, calcium, high dose insulin and phosphodiesterase inhibitors was initiated. Despite this combined therapy the shock persisted. Only after administration of levosimendan, a calcium sensitizer, a normalization of the heart function could be observed. We discuss the danger of combining drugs with negative inotropic properties for rate control in atrial fibrillation and review the therapy with focus on the effects on cardiac cells of all recommended drugs in the treatment of intoxication with betareceptor- and calcium channel blockers.
Asunto(s)
Antagonistas Adrenérgicos beta/efectos adversos , Bisoprolol/efectos adversos , Bloqueadores de los Canales de Calcio/efectos adversos , Diltiazem/efectos adversos , Urgencias Médicas , Choque Cardiogénico/inducido químicamente , Verapamilo/efectos adversos , Antagonistas Adrenérgicos beta/administración & dosificación , Anciano , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/tratamiento farmacológico , Bisoprolol/administración & dosificación , Bloqueadores de los Canales de Calcio/administración & dosificación , Gasto Cardíaco Bajo/diagnóstico , Gasto Cardíaco Bajo/tratamiento farmacológico , Diagnóstico Diferencial , Diltiazem/administración & dosificación , Progresión de la Enfermedad , Relación Dosis-Respuesta a Droga , Interacciones Farmacológicas , Femenino , Humanos , Verapamilo/administración & dosificaciónRESUMEN
We report on a 52-year-old woman with liver cirrhosis who suddenly fell into deep coma after correction of an intercurrent hyponatremia. After exclusion of the commonest causes of coma, the MRI showed a symmetrical osmotic demyelination of both thalami. The newest epidemiological data, the pathophysiology of osmotic demyelination, the threats of the treatment of a prolonged severe hyponatremia as well as the therapeutic options in face of osmotic demyelination are discussed.