title: Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report.
abstract: BACKGROUND
  The purpose of this study is to describe a case where methylene blue improved hemodynamics in a poisoned patient.
  
  
  METHODS
  This is a single case report where a poisoned patient developed vasodilatory shock following ingestion of atenolol, amlodipine, and valsartan. Shock persisted after multiple therapies including vasopressors, high-dose insulin, hemodialysis, and 20% intravenous fat emulsion. Methylene blue (2 mg/kg IV over 30 min) was administered in the ICU with temporal improvement as measured by pulmonary artery catheter hemodynamic data pre- and post-methylene blue administration. Within 1 h of methylene blue administration, systemic vascular resistance improved (240 dyn s/cm5 increased to 1204 dyn s/cm5), and vasopressor requirements decreased with maintenance of mean arterial pressure 60 mmHg.
  
  
  CONCLUSIONS
  Methylene blue may improve hemodynamics in drug-induced vasodilatory shock and should be considered in critically ill patients poisoned with vasodilatory medications refractory to standard therapies.
authors: Minnesota Poison Control System, Hennepin County Medical Center, 701 Park Avenue, Mail Code RL, Minneapolis, MN, 55415, USA. laes0004@gmail.com.
authors: JoAn R
authors: JR
authors: Laes
authors: Hennepin County Medical Center Critical Care Fellowship, Hennepin County Medical Center, Minneapolis, MN, USA.
authors: David M
authors: DM
authors: Williams
authors: Minnesota Poison Control System, Minneapolis, MN, USA.
authors: Jon B
authors: JB
authors: Cole
mesh_terms: D017311:Amlodipine / Q000009:adverse effects; D001262:Atenolol / Q000009:adverse effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008751:Methylene Blue / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D012769:Shock / Q000139:chemically induced / Q000188:drug therapy* / Q000503:physiopathology; D000068756:Valsartan / Q000009:adverse effects; D014664:Vasodilation / Q000187:drug effects
chemical_list: D017311:Amlodipine; D001262:Atenolol; D000068756:Valsartan; D008751:Methylene Blue
keywords: Antidotes; Cardiovascular drugs; Drug overdose; Hemodynamics; Methylene blue; Shock; Vasodilation