Labetalol/lorazepam overdose
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Reactions 1347 - 16 Apr 2011 O S Labetalol/lorazepam overdose Hypotension and bradycardia in a hypothermic patient: case report A 50-year-old woman with hypothermia experienced bradycardia and hypotension after intentional ingestion of an overdose of labetalol and lorazepam [indication and outcomes not stated]. The woman was found unresponsive on the road in sub- freezing temperatures, and was taken to an emergency department with a Glasgow Coma Scale (GCS) score of 3. She was intubated and ventilated. On admission, she had a rectal temperature of 29°C, a HR of 60 beats/min, a BP of 96/58mm Hg and a RR of 12 breaths/min. No signs of trauma were evident. She was rewarmed using warmed normal saline infusion, warmed bladder and gastric irrigation, and external heating measures. Laboratory investigations showed the following values: potassium 2.7 mEq/L, glucose 222 mg/dL, CPK 415 IU/L and lactate 7.5 mEq/L; arterial blood gas analysis on 100% oxygen showed a pCO2 of 31mm Hg, a PaO2 of 274mm Hg and a bicarbonate level of 17 mEq/L. ECG findings were suggestive of hypothermia, with QRS prolongation and Osborn waves. An abdominal CT scan identified large amounts of gastric pill fragments. Approximately 20 capsules were removed through gastric lavage, but could not be identified. The woman’s hypothermia resolved, and she was extubated on day 2. She subsequently admitted to ingesting large amounts of lorazepam and labetalol tablets that had been intended for her son and husband, respectively [ingested dosages and times to reaction onset not stated]. She was transferred to a psychiatric hospital on day 3. Author comment: "Complicating the profound hypothermia was the potentially lethal ingestion of labetalol and lorazepam, which certainly may have contributed to her critical condition. . . Labetalol, a short acting beta-blocker, may have further exacerbated hypotension and bradycardia, although evidence suggests that most cardiac function is resistant to pharmacologic therapy at such low temperatures. However, upon rewarming, these effects may have become more pronounced." Adler P, et al. Hypothermia: An unusual indication for gastric lavage. Journal of Emergency Medicine 40: 176-178, No. 2, Feb 2011. Available from: URL: http:// dx.doi.org/10.1016/j.jemermed.2008.11.024 - USA 803052946 1 Reactions 16 Apr 2011 No. 1347 0114-9954/10/1347-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Labetalol/lorazepam overdose
Reactions 1347 - 16 Apr 2011
O SLabetalol/lorazepam overdose
Hypotension and bradycardia in a hypothermicpatient: case report
A 50-year-old woman with hypothermia experiencedbradycardia and hypotension after intentional ingestion ofan overdose of labetalol and lorazepam [indication andoutcomes not stated].
The woman was found unresponsive on the road in sub-freezing temperatures, and was taken to an emergencydepartment with a Glasgow Coma Scale (GCS) score of 3.She was intubated and ventilated. On admission, she had arectal temperature of 29°C, a HR of 60 beats/min, a BP of96/58mm Hg and a RR of 12 breaths/min. No signs oftrauma were evident. She was rewarmed using warmednormal saline infusion, warmed bladder and gastricirrigation, and external heating measures. Laboratoryinvestigations showed the following values: potassium2.7 mEq/L, glucose 222 mg/dL, CPK 415 IU/L and lactate7.5 mEq/L; arterial blood gas analysis on 100% oxygenshowed a pCO2 of 31mm Hg, a PaO2 of 274mm Hg and abicarbonate level of 17 mEq/L. ECG findings weresuggestive of hypothermia, with QRS prolongation andOsborn waves. An abdominal CT scan identified largeamounts of gastric pill fragments.
Approximately 20 capsules were removed throughgastric lavage, but could not be identified. The woman’shypothermia resolved, and she was extubated on day 2.She subsequently admitted to ingesting large amounts oflorazepam and labetalol tablets that had been intended forher son and husband, respectively [ingested dosages andtimes to reaction onset not stated]. She was transferred to apsychiatric hospital on day 3.
Author comment: "Complicating the profoundhypothermia was the potentially lethal ingestion of labetaloland lorazepam, which certainly may have contributed to hercritical condition. . . Labetalol, a short acting beta-blocker,may have further exacerbated hypotension and bradycardia,although evidence suggests that most cardiac function isresistant to pharmacologic therapy at such low temperatures.However, upon rewarming, these effects may have becomemore pronounced."Adler P, et al. Hypothermia: An unusual indication for gastric lavage. Journal ofEmergency Medicine 40: 176-178, No. 2, Feb 2011. Available from: URL: http://dx.doi.org/10.1016/j.jemermed.2008.11.024 - USA 803052946
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Reactions 16 Apr 2011 No. 13470114-9954/10/1347-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
