title: Usefulness of intravenous lipid emulsion for cardiac toxicity from cocaine overdose.
abstract: The investigators describe the clinical course of a 26-year-old-man who was brought to the emergency department in a comatose state with status epilepticus after smoking a large amount of crack cocaine. In the emergency department, he was intubated because of depressed mental status and respiratory acidosis. His troponin I remained negative, and electrocardiography showed wide-complex tachycardia with a prolonged corrected QT interval. Because of the corrected QT interval prolongation and wide-complex tachycardia, the patient was started on intravenous magnesium sulfate and sodium bicarbonate. Despite these interventions, no improvement in cardiac rhythm was observed, and electrocardiography continued to show wide-complex tachycardia. The patient became more unstable from a cardiovascular standpoint, with a decrease in blood pressure to 85/60 mm Hg. He was then given 100 ml of 20% lipid emulsion (Intralipid). Within 10 minutes of starting the infusion of 20% lipid emulsion, wide-complex tachycardia disappeared, with an improvement in systemic blood pressure to 120/70 mm Hg. Repeat electrocardiography after the infusion of intravenous lipid emulsion showed regular sinus rhythm with normal QRS and corrected QT intervals. The patient was successfully extubated on day 8 of hospitalization and discharged home on day 10. His cardiac rhythm and blood pressure remained stable throughout his further stay in the hospital.
authors.affiliation: Department of Internal Medicine, Wayne State University School of Medicine, Detroit Medical Center, Michigan, USA.
authors.forename: Natasha Purai
authors.initials: NP
authors.lastname: Arora
authors.forename: William Allen
authors.initials: WA
authors.lastname: Berk
authors.forename: Cynthia Kurke
authors.initials: CK
authors.lastname: Aaron
authors.forename: Kim Allan
authors.initials: KA
authors.lastname: Williams
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000150:complications*; D016578:Crack Cocaine / Q000506:poisoning*; D062787:Drug Overdose / Q000150:complications / Q000188:drug therapy*; D004562:Electrocardiography / Q000187:drug effects*; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006321:Heart / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D008297:Male; D013610:Tachycardia / Q000139:chemically induced / Q000188:drug therapy*
chemical_list: D016578:Crack Cocaine; D005217:Fat Emulsions, Intravenous