Medication-induced Takotsubo Cardiomyopathy presenting with cardiogenic shock—utility of extracorporeal membrane oxygenation (ECMO): case report and review of the literature

Rojas-Marte, Geurys; John, Jinu; Sadiq, Adnan; Moskovits, Norbert; Saunders, Paul; Shani, Jacob

doi:10.1016/j.carrev.2014.07.004

Cited by 8 publications

(5 citation statements)

References 26 publications

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“…Metabolic acidosis in ibuprofen overdose is believed to be caused by its metabolism to weak acids and may affect cardiovascular function, decrease cardiac output and vascular tone, and contribute to profound hypotension [ 18 , 19 ]. Furthermore, drug-induced Takotsubo cardiomyopathy has been described in a combined ibuprofen and diphenhydramine-overdose [ 20 ], however, echocardiography in our own case does not point to such a condition. Finally, functional adrenal insufficiency with refractory hypotension in a combined naproxen and ibuprofen overdose – responding to hydrocortisone – was another issue discussed in the literature.…”

Section: Discussioncontrasting

confidence: 55%

Ibuprofen plasma concentration profile in deliberate ibuprofen overdose with circulatory depression treated with therapeutic plasma exchange: a case report

Geith

Renner

Rabe

et al. 2017

BMC Pharmacol Toxicol

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BackgroundInquiries relating to ibuprofen overdose have more than tripled in the last ten years in our poison control center. Although the vast majority of cases have a benign clinical course, there are few severe or even fatal cases present with refractory circulatory failure.Case presentationWe describe a case of a 48 year-old male with suicidal mono-ingestion of approximately 72 g ibuprofen. Despite an initial rapid spontaneous drop in the total ibuprofen plasma concentration (IPC) from 550 to 275 mcg/mL within the first 5 h after admission, the patient developed a circulatory failure, refractory to aggressive fluid resuscitation and high doses of vasopressors. Due to ibuprofen’s favorable pharmacokinetics (>95% bound to albumin, low volume of distribution) and in the absence of specific therapeutic alternatives thereby avoiding escalating vasopressor doses, therapeutic plasma exchange (TPE) for extracorporeal elimination of ibuprofen was considered as a therapeutic rescue option.An improvement of hemodynamics with a significant reduction of vasopressors was observed with TPE-initiation. However, neither the observed IPC-profile nor a pharmacokinetic (PK) simulation provided evidence for a quantitative effective elimination of ibuprofen by TPE. Based on PK-modeling we calculated an overall ibuprofen half-life of 17.2 h for the entire observation period over 5 days.ConclusionsTo our knowledge this is the first report of a severe ibuprofen-mono intoxication treated with TPE and providing serial IPCs over a period of five days, indicating an estimated fivefold overall-elimination half-life of 17.2 h. Despite TPE clinically improved persistent hemodynamic instability, this procedure was neither consistent with the observed IPC-profile nor correlated with a meaningful quantitative elimination of ibuprofen.Electronic supplementary materialThe online version of this article (10.1186/s40360-017-0187-9) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 55%

Ibuprofen plasma concentration profile in deliberate ibuprofen overdose with circulatory depression treated with therapeutic plasma exchange: a case report

Geith

Renner

Rabe

et al. 2017

BMC Pharmacol Toxicol

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“…Treatment with assist devices in TTC patients has been reported in several study populations and single case reports. 8,10,21,22,28 Early mechanical circulatory support in severe CS due to TTC may reduce the need for catecholamines and provide a reasonable strategy in terms of a bridging-to-recovery approach. The successful use of ECMO in a TTC patient with haemodynamic instability is illustrated in Figure 2.…”

Section: Discussionmentioning

confidence: 99%

Incidence, determinants and prognostic relevance of cardiogenic shock in patients with Takotsubo cardiomyopathy

Stiermaier

Eitel

Desch

et al. 2016

European Heart Journal: Acute Cardiovascular Care

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“…137 Ibuprofen was called a cause of TCM, while the patient described in the case suffered cardiac arrest and underwent extensive cardiopulmonary resuscitation with massive doses of epinephrine. 113 Only handful of cases remain unexplained: androgenic steroids in the setting of hypothyroidism, 114 interleukin 2, 115 entacapone, 116 influenza vaccine, 118 dipyridamole, 88 and convulsions and takotsubo in a 97-year-old patient after levofloxacin and a nonsteroidal anti-inflammatory drug loxoprofen. 123…”

Section: Discussionmentioning

confidence: 99%

Drug-Induced Takotsubo Cardiomyopathy

Kido

Guglin

2017

J Cardiovasc Pharmacol Ther

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Medication-induced Takotsubo Cardiomyopathy presenting with cardiogenic shock—utility of extracorporeal membrane oxygenation (ECMO): case report and review of the literature

Cited by 8 publications

References 26 publications

Ibuprofen plasma concentration profile in deliberate ibuprofen overdose with circulatory depression treated with therapeutic plasma exchange: a case report

Ibuprofen plasma concentration profile in deliberate ibuprofen overdose with circulatory depression treated with therapeutic plasma exchange: a case report

Incidence, determinants and prognostic relevance of cardiogenic shock in patients with Takotsubo cardiomyopathy

Drug-Induced Takotsubo Cardiomyopathy

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