title: Effect of lipid emulsion during resuscitation of a patient with cardiac arrest after overdose of chlorpromazine and mirtazapine.
abstract: No specific treatment exists for poisoning with most fat-soluble drugs. Intravenous lipid emulsion (ILE) may be effective therapy against such drugs, but effects of ILE treatment are unclear. A 24-year-old woman with depression seen sleeping in the morning was found comatose in the evening, and an emerging lifesaving technologies service was called. After emerging lifesaving technologies departure to hospital, she stopped breathing, became pulseless, and cardiopulmonary life support was started immediately. Electrocardiographic monitoring showed asystole during resuscitation even after arrival at hospital. Empty packaging sheets of 60-tablet chlorpromazine (CPZ) (50 mg/tablet) and 66-tablet mirtazapine (MZP) (15 mg/tablet) found at the scene suggested drug-related cardiopulmonary arrest. Along with conventional administration of adrenaline (total dose, 5 mg), 20% Intralipid 100 mLwas given intravenously 8 minutes after hospital arrival and readministered 27 minutes after hospital arrival because of continued asystole. Return of spontaneous circulation occurred 29 minutes after arrival (70 minutes after cardiac arrest). The patient recovered without any major complications and was transferred to another hospital for psychiatric treatment 70 days after admission. Concentrations of CPZ and MZP were still high when return of spontaneous circulation was achieved with ILE. This case suggested the possible benefit of ILE in treating life threatening cardiotoxicity from CPZ and MZP overdose.
authors: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. Electronic address: h.matsumoto0828@gmail.com.
authors: Hisatake
authors: H
authors: Matsumoto
authors: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Mitsuo
authors: M
authors: Ohnishi
authors: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Ryosuke
authors: R
authors: Takegawa
authors: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Tomoya
authors: T
authors: Hirose
authors: Department of Pharmacy, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors: Yuji
authors: Y
authors: Hattori
authors: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Takeshi
authors: T
authors: Shimazu
mesh_terms: D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning*; D014150:Antipsychotic Agents / Q000506:poisoning*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002746:Chlorpromazine / Q000506:poisoning*; D003863:Depression / Q000188:drug therapy; D062787:Drug Overdose / Q000628:therapy*; D004655:Emulsions / Q000627:therapeutic use; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced* / Q000628:therapy*; D006801:Humans; D008803:Mianserin / Q000031:analogs & derivatives* / Q000506:poisoning; D000078785:Mirtazapine; D010743:Phospholipids / Q000627:therapeutic use*; D013024:Soybean Oil / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D004655:Emulsions; D005217:Fat Emulsions, Intravenous; D010743:Phospholipids; C545823:soybean oil, phospholipid emulsion; D008803:Mianserin; D013024:Soybean Oil; D000078785:Mirtazapine; D002746:Chlorpromazine