Abstract
Vasopressin is a potent vasopressor used for improving organ perfusion during cardiac
arrest, septic and catecholamine-resistant shock; with reference to this, it is useful
for the treatment of vasoplegic shock because, restoring organ perfusion pressure
by contraction of vascular smooth muscle through a non-catecholamine receptor pathway,
it can be employed when catecholamines are ineffective.
A 49-yr-old woman was admitted to the Emergency Department after having intentionally
taken 95.2 g of metformin, 1.6 g of pioglitazone and 40 UI of insulin glargine in a suicide attempt. Despite fluid
resuscitation, CVVHDF (continuous veno-venous hemodiafiltration) treatment, norepinephrine
and epinephrine infusion, she developed a severe lactic acidosis and a catecholamines-refractive
vasodilatory shock. Only the vasopressin infusion, in association with catecholamines,
gradually stabilized the patient's hemodynamic status.
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References
- Suicide due to massive ingestion of metformin (85 g): lactic acidosis followed by rhabdomyolysis with fatal heart damage.Farm Hosp. 2013; 37: 166-168
- Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.Crit Care Med. 2013 Feb; 41: 580-637https://doi.org/10.1097/CCM.0b013e31827e83af
- Vasopressin and terlipressin in adult vasodilatory shock: a systematic review and meta-analysis of nine randomized controlled trials.Crit Care. 2012; 16: R154
Article Info
Publication History
Published online: October 25, 2017
Accepted:
October 25,
2017
Received in revised form:
October 24,
2017
Received:
October 1,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
