Incidence, causes and prognosis of hypotension related to meprobamate poisoning.
OBJECTIVE
Meprobamate self-poisoning has been reported as potentially inducing hypotension. We examined the incidence and causes of hypotension induced by this poisoning and its prognosis.


METHODS
Retrospective observational study conducted in a medical ICU between June 1997 and October 2003. Seventy-four patients admitted for meprobamate poisoning and needing mechanical ventilation were included. Demographic, clinical, and laboratory data were compared between patients with and without hypotension. All echocardiograms recorded in patients with hypotension were reviewed, and left ventricular (LV) and right ventricular (RV) functions were assessed.


RESULTS
Twenty-nine (40%) patients exhibited hypotension without any significant difference in age, gender, cardiac history, or meprobamate concentration in blood when compared to patients without hypotension. Base excess was significantly lower in patients with hypotension. Echocardiography demonstrated a hypokinetic state, associating decreased LV ejection fraction (45+/-15%) and cardiac index (2+/-0.7 l min(-1) m(-2)), and increased inferior vena cava diameter. Most patients with hypotension received inotropic drugs by infusion, and were ventilated for significantly longer.


CONCLUSIONS
Meprobamate self-poisoning induces hypotension, notably related to cardiac failure, in about 40% of cases. This has important therapeutic consequences, as frequent inotropic drug infusion. The mechanisms of cardiac toxicity remain largely unknown, and no predictive factor could be isolated.
Charron
Cyril
C
Medical Intensive Care Unit, University Hospital Ambroise Paré, AP/HP, 9 avenue Charles de Gaulle, 92104, Boulogne, France.
Mekontso-Dessap
Armand
A
Chergui
Karim
K
Rabiller
Anne
A
Jardin
François
F
Vieillard-Baron
Antoine
A
D000328:Adult; D014151:Anti-Anxiety Agents / Q000097:blood / Q000506:poisoning*; D002606:Charcoal / Q000627:therapeutic use; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007022:Hypotension / Q000139:chemically induced*; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008620:Meprobamate / Q000097:blood / Q000506:poisoning*; D008875:Middle Aged; D011379:Prognosis; D012121:Respiration, Artificial; D012189:Retrospective Studies
D014151:Anti-Anxiety Agents; D002606:Charcoal; D008620:Meprobamate