1. L-Carnitine for the treatment of a calcium channel blocker and metformin poisoning.
- Author
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St-Onge M, Ajmo I, Poirier D, and Laliberté M
- Subjects
- Aged, Antidotes administration & dosage, Antihypertensive Agents antagonists & inhibitors, Calcium Channel Blockers chemistry, Carnitine administration & dosage, Combined Modality Therapy, Drug Overdose drug therapy, Drug Overdose metabolism, Drug Resistance, Ethanol antagonists & inhibitors, Ethanol poisoning, Humans, Hypoglycemic Agents administration & dosage, Hypoglycemic Agents antagonists & inhibitors, Hypoglycemic Agents therapeutic use, Infusions, Intravenous, Insulin administration & dosage, Insulin therapeutic use, Insulin Resistance, Male, Metformin antagonists & inhibitors, Shock etiology, Shock prevention & control, Suicide, Attempted, Treatment Outcome, Vitamin B Complex administration & dosage, Vitamin B Complex therapeutic use, Antidotes therapeutic use, Antihypertensive Agents poisoning, Calcium Channel Blockers poisoning, Carnitine therapeutic use, Drug Overdose therapy, Hypoglycemic Agents poisoning, Metformin poisoning
- Abstract
Introduction: The object of the current communication is to discuss the theory and the evidence for the use of L-carnitine in calcium channel blocker and metformin poisonings., Case Report: A 68-year-old male known for hypertension and type II diabetes was admitted to the critical care unit of a community hospital following an overdose of amlodipine and metformin. The patient was intubated, ventilated, and hemodynamically supported with vasopressors. Despite calcium, glucagon, high-dose insulin (HDI), and lipid emulsion for calcium channel blocker and bicarbonate for metabolic acidosis, the patient remained hemodynamically unstable. The patient was considered too unstable to initiate continuous renal replacement therapy; and without access to extracorporeal life support, the administration of L-carnitine was administered as a last resort. One hour after L-carnitine, the norepinephrine requirements started to decrease, the patient began to improve and was subsequently extubated successfully without apparent sequelae in less than 4 days., Discussion: L-Carnitine combined with HDI may have helped with the calcium channel blocker (CCB) poisoning by decreasing insulin resistance, promoting intracellular glucose transport, facilitating the metabolism of free fatty acids, and increasing calcium channel sensitivity. It may have also stimulated oxidative utilization of glucose instead of converting pyruvate into lactate and contributed to decrease lactate production with metformin poisoning.
- Published
- 2013
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