Restricted accessResearch articleFirst published online 2017-7
Venlafaxine Intoxication with Development of Takotsubo Cardiomyopathy: Successful Use of Extracorporeal Life Support,Intravenous Lipid Emulsion and Cytosorb ®
We describe a young patient who ingested 18 g (240 times the daily therapeutic dose) of venlafaxine in a suicide attempt. She developed severe cardiomyopathy in a takotsubo distribution causing cardiogenic shock and multi-organ dysfunction syndrome (MODS). She was successfully treated with intravenous lipid emulsion (ILE), extracorporeal life support (ECLS) and CytoSorb®. This is remarkable as, to the best of the authors’ knowledge, this is the highest amount of venlafaxine intake seen in the literature with a nonfatal outcome.
PrasadA., LermanA., RihalC.S.Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J.2008; 155(3): 408–417.
2.
FettiplaceM.R., WeinbergG.Past, Present, and Future of Lipid Resuscitation Therapy. J Parenter Enteral Nutr.2015; 39(1 Suppl): 72S–83S.
3.
HillyardS.G., Barrera-GrobaC., TigheR.Intralipid reverses coma associated with zopiclone and venlafaxine overdose. Eur J Anaesthesiol.2010; 27(6): 582–583.
4.
DagtekinO., MarcusH., MüillerC., BöttigerB.W., SpöhrF.Lipid therapy for serotonin syndrome after intoxication with venlafaxine, lamotrigine and diazepam. Minerva Anestesiol.2011; 77(1): 93–95.
5.
CaveG., HarveyM.G.Should we consider the infusion of lipid emulsion in the resuscitation of poisoned patients?Crit Care.2014; 18(5): 457.
ChristophM., EbnerB., StolteD.. Broken heart syndrome: Tako Tsubo cardiomyopathy associated with an overdose of the serotonin-norepinephrine reuptake inhibitor Venlafaxine. Eur Neuropsychopharmacol.2010; 20(8): 594–597.
8.
PatonL., QuasimI.Takotsubo cardiomyopathy: issues for the intensivist. Br J Anaesth.2013; 110(6): 1058.
9.
BonacchiM., MaianiM., HarmelinG., SaniG.Intractable cardiogenic shock in stress cardiomyopathy with left ventricular outflow tract obstruction: is extra-corporeal life support the best treatment?Eur J Heart Fail.2009; 11(7): 721–727.
10.
HonoreP.M., JacobsR., Joannes-BoyauO.. Newly designed CRRT membranes for sepsis and SIRSA pragmatic approach for bedside intensivists summarizing the more recent advances: a systematic structured review. ASAIO J.2013; 59(2): 99–106.
11.
ReiterK., BordoniV., DallòlioG.. In vitro removal of therapeutic drugs with a novel adsorbent system. Blood Purif.2002; 20(4): 380–388.
LeeH.M., ArcherJ.R., DarganP.I., WoodD.M.What are the adverse effects associated with the combined use of intravenous lipid emulsion and extracorporeal membrane oxygenation in the poisoned patient?Clin Toxicol (Phila).2015; 53(3): 145–150.
