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Multi-drug intoxication fatality involving atorvastatin: A case report
L. Cibickova, T. Caran, M. Dobias, P. Ondra, V. Vorisek, N. Cibicek,
Jazyk angličtina Země Irsko
Typ dokumentu kazuistiky, časopisecké články
NLK
ProQuest Central
od 1997-02-07 do Před 2 měsíci
Nursing & Allied Health Database (ProQuest)
od 1997-02-07 do Před 2 měsíci
Health & Medicine (ProQuest)
od 1997-02-07 do Před 2 měsíci
- MeSH
- akutní poškození ledvin chemicky indukované MeSH
- alkoholici MeSH
- anthrachinony analýza otrava MeSH
- antiflogistika analýza otrava MeSH
- antihypertenziva analýza otrava MeSH
- atorvastatin analýza otrava MeSH
- gastrointestinální obsah chemie MeSH
- imidazoly analýza otrava MeSH
- indoly analýza otrava MeSH
- lidé MeSH
- piperaziny analýza otrava MeSH
- předávkování léky MeSH
- rhabdomyolýza chemicky indukované patologie MeSH
- sebevražda * MeSH
- senioři MeSH
- soudní toxikologie MeSH
- statiny analýza otrava MeSH
- vazodilatancia analýza otrava MeSH
- verapamil analýza otrava MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Mixed antihypertensive drug intoxication poses a significant risk for patient mortality. In tandem to antihypertensives, hypolipidemic medicines (especially statins) are often prescribed. Among their well-known adverse effects belongs rhabdomyolysis. We report a case of fatal multi-drug overdose in a 65-year-old female alcoholic. The patient was unconscious at admission. Empty blister packs indicated the abuse of 250 tablets of urapidil, 42 tablets of verapamil/trandolapril, 50 tablets of moxonidin, 80 tablets of atorvastatin and 80 tablets of diacerein. Standard measures (gastric lavage, activated charcoal, mechanical ventilation, massive doses of vasopressors, volume expansion, diuretics and alkalinization) failed to provide sufficient drug elimination and hemodynamic support and the sufferer deceased on the fourth day. Dramatic elevations of serum myoglobin (34,020 μg/L) and creatine kinase (219 μkat/L) were accompanied by rise in cardiac troponin I and creatinine. Gas chromatography revealed ethanol 1.17 g/kg (blood) and 2.81 g/kg (urine). Thin layer chromatography and gas chromatography of gastric content and urine verified verapamil, moxonidin and urapidil fragment (diacerein method was unavailable). Atorvastatin and trandolapril concentrations (LC-MS(n)) equaled 277.7 μg/L and 57.5 μg/L, resp. (serum) and 8.15 μg/L and 602.3 μg/L, resp. (urine). Histology confirmed precipitates of myoglobin with acute necrosis of proximal renal tubules in association with striated muscle rhabdomyolysis and myocardial dystrophy. Cardiogenic-distributive shock in conjunction with acute renal failure due to the combined self-poisoning with vasoactive agents and atorvastatin were determined to be this decedent's immediate cause of death. The manner of death was assigned to be suicidal.
Citace poskytuje Crossref.org
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- $a Cibickova, Lubica $u 3(rd) Department of Internal Medicine-Nephrology, Rheumatology and Endocrinology, Palacky University Olomouc, Faculty of Medicine and Dentistry, Hněvotínská 3, 775 15 Olomouc, Czech Republic.
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- $a Multi-drug intoxication fatality involving atorvastatin: A case report / $c L. Cibickova, T. Caran, M. Dobias, P. Ondra, V. Vorisek, N. Cibicek,
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- $a Mixed antihypertensive drug intoxication poses a significant risk for patient mortality. In tandem to antihypertensives, hypolipidemic medicines (especially statins) are often prescribed. Among their well-known adverse effects belongs rhabdomyolysis. We report a case of fatal multi-drug overdose in a 65-year-old female alcoholic. The patient was unconscious at admission. Empty blister packs indicated the abuse of 250 tablets of urapidil, 42 tablets of verapamil/trandolapril, 50 tablets of moxonidin, 80 tablets of atorvastatin and 80 tablets of diacerein. Standard measures (gastric lavage, activated charcoal, mechanical ventilation, massive doses of vasopressors, volume expansion, diuretics and alkalinization) failed to provide sufficient drug elimination and hemodynamic support and the sufferer deceased on the fourth day. Dramatic elevations of serum myoglobin (34,020 μg/L) and creatine kinase (219 μkat/L) were accompanied by rise in cardiac troponin I and creatinine. Gas chromatography revealed ethanol 1.17 g/kg (blood) and 2.81 g/kg (urine). Thin layer chromatography and gas chromatography of gastric content and urine verified verapamil, moxonidin and urapidil fragment (diacerein method was unavailable). Atorvastatin and trandolapril concentrations (LC-MS(n)) equaled 277.7 μg/L and 57.5 μg/L, resp. (serum) and 8.15 μg/L and 602.3 μg/L, resp. (urine). Histology confirmed precipitates of myoglobin with acute necrosis of proximal renal tubules in association with striated muscle rhabdomyolysis and myocardial dystrophy. Cardiogenic-distributive shock in conjunction with acute renal failure due to the combined self-poisoning with vasoactive agents and atorvastatin were determined to be this decedent's immediate cause of death. The manner of death was assigned to be suicidal.
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- $a Caran, Tomas $u Department of Anesthesiology and Resuscitation, Hospital Hranice, Zborovská 1245, 753 22 Hranice, Czech Republic.
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- $a Vorisek, Viktor $u Institute of Clinical Biochemistry and Diagnostics, Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic.
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- $a Cibicek, Norbert $u Department of Medical Chemistry and Biochemistry, Palacky University Olomouc, Faculty of Medicine and Dentistry, Hněvotínská 3, 775 15 Olomouc, Czech Republic. Electronic address: norbert.cibicek@upol.cz.
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