PMID- 37542369
OWN - NLM
STAT- MEDLINE
DCOM- 20230807
LR  - 20230811
IS  - 1941-5923 (Electronic)
IS  - 1941-5923 (Linking)
VI  - 24
DP  - 2023 Aug 5
TI  - Effective Treatment of Acute Tricyclic Antidepressant Poisoning with Cardiogenic 
      Shock and Severe Rhabdomyolysis Using ECMO and CytoSorb(R) Adsorber.
PG  - e939884
LID - 10.12659/AJCR.939884 [doi]
AB  - BACKGROUND Tricyclic antidepressant (TCA) drugs are a common cause of fatal 
      poisoning because of their cardiotoxic and arrhythmogenic effects. Classic 
      supportive management includes sodium bicarbonate, gastrointestinal chelating 
      agents, and vasopressors. Recently, intravenous lipid emulsion (supported by a 
      low evidence level) has also been used. CASE REPORT We report the case of a 
      55-year-old woman admitted to our Intensive Care Unit (ICU) with acute imipramine 
      self-poisoning. She arrived at the emergency department 7 hours after imipramine 
      ingestion; she had severe rhabdomyolysis upon admission, with creatine 
      phosphokinase levels at about 52 500 IU/L (normal, <200 IU/L). She quickly 
      developed cardiogenic shock and malign arrhythmia requiring veno-arterial extra 
      corporeal membrane oxygenation (VA-ECMO). Continuous renal replacement therapy 
      (CRRT) with CytoSorb(R) (CytoSorbents, Monmouth Junction, New York, United Sates of 
      America) was started 19 hours after admission. We performed serial blood 
      measurements of imipramine and its active metabolite desipramine as well as 
      viewing the levels on the CRRT-circuit monitor. Cardiac function improved and 
      ECMO was explanted after 4 days. She also had severe acute respiratory distress 
      syndrome, which resolved spontaneously. The neurologic outcome was favorable 
      despite early myoclonus. The patient regained consciousness on the fifth day. Her 
      clinical evolution was marked by acute ischemia of the lower left limb due to the 
      arterial ECMO cannula. CONCLUSIONS These measurements document the efficacy of 
      the CytoSorb(R) adsorber in removing a lipophilic drug from a patient's 
      bloodstream. To our knowledge, this is the first published case of CytoSorb(R) 
      extracorporeal blood purification therapy for acute TCA poisoning.
FAU - Zitoune, Zakaria
AU  - Zitoune Z
AUID- ORCID: 0000-0001-6885-414X
AD  - Intensive Care Department, CHU UCL Godinne Namur, Louvain Medical School, Namur, 
      Belgium.
FAU - Kugener, Luc
AU  - Kugener L
AUID- ORCID: 0000-0001-6174-9347
AD  - Intensive Care Unit, IRIS Sud Hospitals, Brussels, Belgium.
FAU - Jonckheer, Joop
AU  - Jonckheer J
AUID- ORCID: 0000-0002-7477-600X
AD  - Department of Intensive Care Unit, Universiteit Ziekenhuis Brussel, Brussels, 
      Belgium.
FAU - Lanckmans, Katrien
AU  - Lanckmans K
AUID- ORCID: 0000-0001-7992-6364
AD  - Toxicology Laboratory, Department of Biology, Universiteit Ziekenhuis Brussel, 
      Brussels, Belgium.
FAU - Hantson, Philippe
AU  - Hantson P
AUID- ORCID: 0000-0003-4409-3352
AD  - Department of Intensive Care, Cliniques Universitaires Saint Luc, Brussels, 
      Belgium.
FAU - Devriendt, Jacques
AU  - Devriendt J
AUID- ORCID: 0000-0002-9899-2866
AD  - Department of Intensive Care, Brugmann University Hospital, Brussels, Belgium.
FAU - Honore, Patrick M
AU  - Honore PM
AUID- ORCID: 0000-0002-6697-4890
AD  - Intensive Care Department, CHU UCL Godinne Namur, Louvain Medical School, Namur, 
      Belgium.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20230805
PL  - United States
TA  - Am J Case Rep
JT  - The American journal of case reports
JID - 101489566
RN  - 0 (Antidepressive Agents, Tricyclic)
RN  - OGG85SX4E4 (Imipramine)
SB  - IM
MH  - Female
MH  - Humans
MH  - Middle Aged
MH  - *Shock, Cardiogenic/chemically induced/therapy
MH  - Antidepressive Agents, Tricyclic
MH  - *Extracorporeal Membrane Oxygenation
MH  - Imipramine
PMC - PMC10411287
COIS- Conflict of interest: None declared
EDAT- 2023/08/05 11:43
MHDA- 2023/08/07 06:42
PMCR- 2023/08/05
CRDT- 2023/08/05 01:22
PHST- 2023/08/07 06:42 [medline]
PHST- 2023/08/05 11:43 [pubmed]
PHST- 2023/08/05 01:22 [entrez]
PHST- 2023/08/05 00:00 [pmc-release]
AID - 939884 [pii]
AID - 10.12659/AJCR.939884 [doi]
PST - epublish
SO  - Am J Case Rep. 2023 Aug 5;24:e939884. doi: 10.12659/AJCR.939884.