Amiodarone toxicity: An underdiagnosed entity

Xavier, Joseph; Haranal, Maruti; Reddy, Shashidhar Ranga; Melagiriyappa, Sridhar

doi:10.4103/0974-2069.180671

Cited by 3 publications

(1 citation statement)

References 4 publications

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“…In the primary logistic regression, exposure to alpha-2 agonists or antiarrhythmics were independent risk factors for PICU intervention. Antiarrhythmic exposure was associated with greater than four times odds of PICU intervention in both the main and sensitivity analyses; these exposures were infrequent but often clinically significant, consistent with prior literature (28, 29). In the sensitivity analysis, calcium channel antagonist exposure became an independent risk factor, suggesting that calcium channel antagonists may be associated with the need for more critical interventions.…”

Section: Discussionsupporting

confidence: 84%

Intensive Care Interventions Among Children With Toxicologic Exposures to Cardiovascular Medications

Simpson

Watson

Whitledge

et al. 2023

Pediatric Critical Care Medicine

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OBJECTIVES: Interventions requiring a PICU are rare in toxicologic exposures, but cardiovascular medications are high-risk exposures due to their hemodynamic effects. This study aimed to describe prevalence of and risk factors for PICU interventions among children exposed to cardiovascular medications. DESIGN: Secondary analysis of Toxicology Investigators Consortium Core Registry from January 2010 to March 2022. SETTING: International multicenter research network of 40 sites. PATIENTS: Patients 18 years old or younger with acute or acute-on-chronic toxicologic exposure to cardiovascular medications. Patients were excluded if exposed to noncardiovascular medications or if symptoms were documented as unlikely related to exposure. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 1,091 patients in the final analysis, 195 (17.9%) received PICU intervention. One hundred fifty-seven (14.4%) received intensive hemodynamic interventions and 602 (55.2%) received intervention in general. Children less than 2 years old were less likely to receive PICU intervention (odds ratio [OR], 0.42; 95% CI, 0.20–0.86). Exposures to alpha-2 agonists (OR, 2.0; 95% CI, 1.11–3.72) and antiarrhythmics (OR, 4.26; 95% CI, 1.41–12.90) were associated with PICU intervention. In the sensitivity analysis removing atropine from the composite outcome PICU intervention, only exposures to calcium channel antagonists (OR, 2.12; 95% CI, 1.09–4.11) and antiarrhythmics (OR, 4.82; 95% CI, 1.57–14.81) were independently associated with PICU intervention. No independent association was identified between PICU intervention and gender, polypharmacy, intentionality or acuity of exposure, or the other medication classes studied. CONCLUSIONS: PICU interventions were uncommon but were associated with exposure to antiarrhythmic medications, calcium channel antagonists, and alpha-2 agonists. As demonstrated via sensitivity analysis, exact associations may depend on institutional definitions of PICU intervention. Children less than 2 years old are less likely to require PICU interventions. In equivocal cases, age and exposure to certain cardiovascular medication classes may be useful to guide appropriate disposition.

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Section: Discussionsupporting

confidence: 84%

Intensive Care Interventions Among Children With Toxicologic Exposures to Cardiovascular Medications

Simpson

Watson

Whitledge

et al. 2023

Pediatric Critical Care Medicine

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Cardiovascular Collapse with Intravenous Amiodarone in Children: A Multi-Center Retrospective Cohort Study

et al. 2019

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Hemodynamic profile effects of PM101 amiodarone formulation in patients with post-operative tachyarrhythmias

DeCoy

Page-Goertz²,

Nofziger³

et al. 2022

Cardiol Young

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Amiodarone may be considered for patients with junctional ectopic tachycardia refractory to treatment with sedation, analgesia, cooling, and electrolyte replacements. There are currently no published pediatric data regarding the hemodynamic effects of the newer amiodarone formulation, PM101, devoid of hypotensive agents used in the original amiodarone formulation. We performed a single-center, retrospective, descriptive study from January 2012 to December 2020 in a pediatric ICU. Thirty-three patients were included (22 male and 11 female) between the ages of 1.1 and 1,460 days who developed post-operative junctional ectopic tachycardia or other tachyarrhythmias requiring PM101. Data analysis was performed on hemodynamic parameters (mean arterial pressures and heart rate) and total PM101 (mg/kg) from hour 0 of amiodarone administration to hour 72. Adverse outcomes were defined as Vasoactive-Inotropic Score >20, patients requiring ECMO or CPR, or patient death. There was no statistically significant decrease in mean arterial pressures within the 6 hours of PM101 administration (p > 0.05), but there was a statistically significant therapeutic decrease in heart rate for resolution of tachyarrhythmia (p < 0.05). Patients received up to 25 mg/kg in an 8-hour time for rate control. Average rate control was achieved within 11.91 hours and average rhythm control within 62 hours. There were four adverse events around the time of PM101 administration, with three determined to not be associated with the medication. PM101 is safe and effective in the pediatric cardiac surgical population. Our study demonstrated that PM101 can be used in a more aggressive dosing regimen than previously reported in pediatric literature with the prior formulation.

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Amiodarone toxicity: An underdiagnosed entity

Cited by 3 publications

References 4 publications

Intensive Care Interventions Among Children With Toxicologic Exposures to Cardiovascular Medications

Intensive Care Interventions Among Children With Toxicologic Exposures to Cardiovascular Medications

Cardiovascular Collapse with Intravenous Amiodarone in Children: A Multi-Center Retrospective Cohort Study

Hemodynamic profile effects of PM101 amiodarone formulation in patients with post-operative tachyarrhythmias

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