Innovative use of Intralipid in Critical Care Setting-Juniper Publishers

JUNIPER PUBLISHERS- OPEN ACCESS JOURNAL OF TOXICOLOGY



Innovative use of Intralipid in Critical Care Setting


Authored by Vikram Anumakonda

 

Abstract

A 42-year-old gentleman presented to hospital emergency department (ED), following a deliberate self-harm with an intentional overdose of 75mg Ramipril, 450mg Amlodipine and 10mg Penicillamine. His initial toxicology screen was negative for paracetamol, salicylate, alcohol or illicit drug. He had a single functioning left kidney, on background of hypertension, cysteinuria, chronic kidney disease (baseline creatinine 130150).

On presentation to the resuscitation unit, he was normocardic (60/minute), hypotensive (88/41mmHg). His GCS was 15. He was oliguric. His preliminary blood tests revealed new onset acute kidney injury. His ECG showed normal sinus rhythm with a normal QTc. Blood gas analysis revealed compensated metabolic acidosis; pH and lactate were within normal limits, but his base excess was -3.7.

Despite intensive fluid resuscitation and administration of glucagon and calcium chloride to antagonise calcium channel blocker in the resuscitation department, he remained persistently hypotensive and oliguric. He only passed 30mls ofurine during his 8 hours of being in hospital, and his base excess was static around -3.0.

He was admitted to the intensive care unit for vasopressor support, with an intent of improve blood perfusion to his only kidney, to mitigate further insult to his remaining renal function. He was started on noradrenaline with a target invasive mean arterial blood pressure (MAP) of 65-70mmHg. However, his MAP did not respond to maximum dose of noradrenaline and crystalloids. In view of his deliberate over dose, the National In patient Poisons Service (NPIS) advice was sought. They advised to start patient on insulin infusion with back ground 10% glucose infusion and supportive therapy.

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