title: Continuous levosimendan infusion for refractory cardiogenic shock complicating severe acute dichlorvos poisoning.
abstract: Respiratory failure is the leading cause of death after organophosphorus poisoning. Cardiac complications are rare, serious and little known to clinicians. The authors present a case of a 74-year-old man with refractory cardiogenic shock after taking 200 mL of 80% dichlorvos for a suicide attempt. This study represents the first reported cardiogenic shock resulting from organophosphorus poisoning in the literature, clarifying its hemodynamic features with invasive hemodynamic monitoring (PiCCO; Pulsion Medical Systems AG, Munich, Germany). Additional levosimendan infusion was commenced after insufficient conventional therapies, resulting in an increase in cardiac power index by 236% and a decrease in systemic vascular resistance by 69% after 24 hours of continuous infusion. Despite the immense hemodynamic improvement after levosimendan treatment, the patient died of multiple organ failure 6 days after admission. The authors also discussed the inotropic and vasodilatory effects of levosimendan in this clinical scenario.
authors: Department of Intensive Care Medicine, Affiliated Hospital of the Medical College of the Chinese People's Armed Police Forces, Tianjin, China.
authors: Yang
authors: Y
authors: Liu
authors: Bin
authors: B
authors: Liu
authors: Hong
authors: H
authors: Zhou
authors: Lu-Qing
authors: LQ
authors: Wei
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D004006:Dichlorvos / Q000506:poisoning*; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage*; D007306:Insecticides / Q000506:poisoning*; D008297:Male; D011724:Pyridazines / Q000008:administration & dosage*; D012770:Shock, Cardiogenic / Q000139:chemically induced* / Q000188:drug therapy*; D000077464:Simendan
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D007306:Insecticides; D011724:Pyridazines; D000077464:Simendan; D004006:Dichlorvos