RESUMO
BACKGROUND: Hypertensive urgency is a clinical scenario that may be associated with herbal supplement use and that requires special consideration with regard to emergency department management. CASE REPORT: A 49-year-old man presented to the emergency department with palpitations and severely elevated blood pressure without evidence of end organ dysfunction. Hypertension failed to be controlled with multiple doses of oral clonidine and intravenous labetalol. The patient later admitted to using an herbal supplement containing yohimbine, a selective âº2-adrenoreceptor antagonist specifically linked to cases of refractory hypertension. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Between 17-35% of the U.S. adult population may use herbal supplements on a sporadic or regular basis; pharmacologically active agents in herbal supplements may affect both a patient's presentation and response to treatment. Most patients do not mention over-the-counter and herbal products in their medication profile unless specifically asked, and therefore it is important for emergency physicians to be aware of the pharmacologic effects of herbal supplements in the evaluation and treatment of refractory severe hypertension.
Assuntos
Pressão Sanguínea/efeitos dos fármacos , Hipertensão/etiologia , Pausinystalia/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Clonidina/uso terapêutico , Suplementos Nutricionais/efeitos adversos , Eletrocardiografia/métodos , Serviço Hospitalar de Emergência/organização & administração , Humanos , Labetalol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pausinystalia/metabolismoRESUMO
In 2013 the Dutch authorities issued a warning against a dietary supplement that was linked to 11 reported adverse reactions, including heart problems and in one case even a cardiac arrest. In the UK a 20-year-old woman, said to have overdosed on this supplement, died. Since according to the label the product was a herbal mixture, initial LC-MS/MS analysis focused on the detection of plant toxins. Yohimbe alkaloids, which are not allowed to be present in herbal preparations according to Dutch legislation, were found at relatively high levels (400-900 mg kg(-1)). However, their presence did not explain the adverse health effects reported. Based on these effects the supplement was screened for the presence of a ß-agonist, using three different biosensor assays, i.e. the validated competitive radioligand ß2-adrenergic receptor binding assay, a validated ß-agonists ELISA and a newly developed multiplex microsphere (bead)-based ß-agonist assay with imaging detection (MAGPIX(®)). The high responses obtained in these three biosensors suggested strongly the presence of a ß-agonist. Inspection of the label indicated the presence of N-isopropyloctopamine. A pure standard of this compound was bought and shown to have a strong activity in the three biosensor assays. Analysis by LC-full-scan high-resolution MS confirmed the presence of this 'unknown known' ß3-agonist N-isopropyloctopamine, reported to lead to heart problems at high doses. A confirmatory quantitative analysis revealed that one dose of the preparation resulted in an intake of 40-60 mg, which is within the therapeutic range of this compound. The case shows the strength of combining bioassays with chemical analytical techniques for identification of illegal pharmacologically active substances in food supplements.
Assuntos
Agonistas de Receptores Adrenérgicos beta 3/intoxicação , Antipirina/análogos & derivados , Depressores do Apetite/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Contaminação de Alimentos , Cardiopatias/etiologia , Preparações de Plantas/efeitos adversos , Agonistas de Receptores Adrenérgicos beta 3/análise , Alcaloides/análise , Alcaloides/toxicidade , Anabolizantes/efeitos adversos , Anabolizantes/química , Anabolizantes/intoxicação , Anabolizantes/normas , Antipirina/análise , Antipirina/intoxicação , Depressores do Apetite/química , Depressores do Apetite/intoxicação , Depressores do Apetite/normas , Técnicas Biossensoriais , Suplementos Nutricionais/análise , Suplementos Nutricionais/intoxicação , Suplementos Nutricionais/normas , Inspeção de Alimentos , Rotulagem de Alimentos , Doenças Transmitidas por Alimentos/etiologia , Doenças Transmitidas por Alimentos/mortalidade , Doenças Transmitidas por Alimentos/terapia , Cardiopatias/mortalidade , Cardiopatias/terapia , Hospitalização , Humanos , Internet , Países Baixos , Nootrópicos/efeitos adversos , Nootrópicos/química , Nootrópicos/intoxicação , Nootrópicos/normas , Pausinystalia/efeitos adversos , Pausinystalia/química , Substâncias para Melhoria do Desempenho/efeitos adversos , Substâncias para Melhoria do Desempenho/química , Substâncias para Melhoria do Desempenho/intoxicação , Substâncias para Melhoria do Desempenho/normas , Preparações de Plantas/química , Preparações de Plantas/intoxicação , Preparações de Plantas/normasAssuntos
Suplementos Nutricionais/efeitos adversos , Fitoterapia/efeitos adversos , Preparações de Plantas/efeitos adversos , Aconitum/efeitos adversos , Publicidade , Chelidonium/efeitos adversos , Citrus/efeitos adversos , Coloides/efeitos adversos , Confrei/efeitos adversos , Interações Medicamentosas , Germânio/efeitos adversos , Regulamentação Governamental , Humanos , Kava/efeitos adversos , Larrea/efeitos adversos , Lobelia/efeitos adversos , Malvaceae/efeitos adversos , Medicamentos sem Prescrição/efeitos adversos , Pausinystalia/efeitos adversos , Preparações de Plantas/uso terapêutico , Rotulagem de Produtos , Prata/efeitos adversos , Esteroides/efeitos adversos , Tussilago/efeitos adversos , Estados Unidos , United States Food and Drug AdministrationRESUMO
Extracts of the bark of the central African tree Pausinystalia yohimbe contain yohimbine, an indole alkaloid, which is used to treat erectile dysfunction. The reported side effects of over-the-counter preparations of yohimbine include gastrointestinal upset, anxiety, increased blood pressure, headache, agitation, rash, tachycardia, and frequent urination. In this report, we describe a severe case of intractable priapism associated with the ingestion of yohimbe extract. Management required insertion of a proximal cavernosal spongiosum shunt (Quackles shunt) in the operating room.