title: Severe propranolol and ethanol overdose with wide complex tachycardia treated with intravenous lipid emulsion: a case report.
abstract: BACKGROUND
  Propranolol is a highly lipid-soluble beta-blocker. We describe a case of severe propranolol overdose, with atypical dysrhythmia--wide complex tachycardia--which was successfully treated with lipid emulsion.
  
  
  METHODS
  A 31-year-old woman ingested approximately 3.6 g of propranolol along with ethanol. Clinical manifestations of poisoning included coma, seizures, respiratory failure, hypoglycaemia, circulatory shock, and dysrhythmias. An ECG revealed nonspecific intraventricular conduction delay, followed by wide complex supraventricular tachycardia. Toxicological analysis of blood showed ethanol 2.42 g/L and propranolol 4.21 mg/L. The patient responded poorly to conventional therapy, so intravenous lipid emulsion was used. Apart from IV dopamine, the only treatment after the onset of wide complex tachycardia was 20% Intralipid. Transient improvement was noticed after the initial dose of 500 mL; during the infusion of further Intralipid, blood pressure returned to normal and sinus rhythm was re-established.
  
  
  CONCLUSIONS
  We believe that lipid emulsion had a beneficial effect in the treatment of propranolol toxicity.
authors: Clinic for Emergency and Clinical Toxicology, Military Medical Academy, Crnotravska 17, Belgrade, Serbia. stosic.sajt@sbb.rs
authors: Jasmina
authors: J
authors: Jovic-Stosic
authors: Branko
authors: B
authors: Gligic
authors: Vesna
authors: V
authors: Putic
authors: Gordana
authors: G
authors: Brajkovic
authors: Radenko
authors: R
authors: Spasic
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000506:poisoning*; D000328:Adult; D062787:Drug Overdose; D004562:Electrocardiography; D000431:Ethanol / Q000506:poisoning*; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D011433:Propranolol / Q000506:poisoning*; D013610:Tachycardia / Q000139:chemically induced*
chemical_list: D000319:Adrenergic beta-Antagonists; D005217:Fat Emulsions, Intravenous; D000431:Ethanol; D011433:Propranolol