Ricerca avanzata

Home > Riviste > Minerva Anestesiologica > Fascicoli precedenti > Minerva Anestesiologica 2008 Marzo;74(3) > Minerva Anestesiologica 2008 Marzo;74(3):97-100



Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,036

Periodicità: Mensile

ISSN 0375-9393

Online ISSN 1827-1596


Minerva Anestesiologica 2008 Marzo;74(3):97-100


Successful treatment of a massive atenolol and nifedipine overdose with CVVHDF

Pfaender M. 1, Casetti P. G. 1, Azzolini M. 1, Baldi M. L. 2, Valli A. 2

1 Unit of Anesthesia and Intensive Care, S. Maria del Carmine Hospital, Rovereto (TN), Italy;
2 Laboratory of Analytical Toxicology, Division of Chemical and Clinical Analysis, S. Matteo Polyclinic, IRCCS, Pavia, Italy

The aim of this paper was to describe a case of massive atenol and nifedipine poisoning, complicated by the co-existence of liver cirrhosis, where standard therapies (fluid replacement, vasopressors and inotropic agents, insulin, glucagon, calcium and bowel decontamination) were ineffective in restoring an adequate heart rate, blood pressure, renal and intestinal blood flow. This led to consequent anuric renal insufficiency and incipient multiple organ failure syndrome (MOFS). The patient recovered completely after Continuous Veno-Venous Hemo-Dia-Filtration (CVVHDF); this treatment removed atenolol from blood, with predicted clearance levels. The patient was a 45-year old female with a history of hypertension, liver cirrhosis, neurological and psychiatric disorders, with a massive atenolol (69.6 µg/mL) and nifedipine (63 ng/mL) overdose. CVVHDF at an ultrafiltration rate of 1 500 mL/h was started on day 1. From day 2 onwards, as the plasma atenolol concentration decreased, the blood pressure rose at a slow but constant rate. On day 5, there was restoration of an adequate blood pressure, which restored both renal and intestinal function, and also improved MOFS. The standard therapeutic approach was ineffective at eliminating both substances from the blood, and the clinical picture became worse due to incipient MOFS. CVVHDF was used in order to maintain the fluid and electrolyte balance and also to clear the beta blocker from the blood. The clearance kinetics of atenolol were consistent with the expected clearance values, on the basis of a CVVHDF ultrafiltration flow of 1 500 mL/h, which corresponds to a creatinine clearance of about 25 mL/min.

lingua: Inglese


inizio pagina