Abstract
Calcium channel blockers (CCB) drugs poisoning continues to be deadly in severe cases despite recent advances and aggressive therapies. Clinically, this toxicity can manifest into severe cardiogenic shock that is often unresponsive to conventional calcium and supportive treatment. This study aimed to investigate the effectiveness of L-carnitine, as an essential compound in cellular energy production, and intralipid emulsion 20% (ILE), as an adjunctive antidote used in selected critically ill poisoned patients, for the treatment of hypotension, Electrocardiogram (ECG) changes and arterial blood gases (ABG) deficits in verapamil poisoned rats, either separately or in combination. The study was conducted on 64 albino rats divided into 8 groups (each of 8 rats). The groups are: group 1 (negative control group), group 2 (L-carnitine group), group 3 (ILE group), group4 (L-carnitine and ILE group), group 5 (verapamil group), group 6 (verapamil and L-carnitine group), group7 (verapamil and ILE group), group8 (verapamil, L-carnitine and ILE group). All animals were subjected to measurement of blood pressure, ECG recording, as well as ABG. Results: verapamil toxicity in group 5 was manifested by significant hypotension (both systolic and diastolic), ECG derangements in the form of bradycardia, prolongation of PR and QT intervals and ABG changes in the form of significant low (pH, HCO3, PaO2 and PaCO2). L-carnitine and ILE separate administration with verapamil in group 6 and group 7 respectively improved the blood pressure, heart rate, ECG and ABG parameters but they still showed statistical significant difference with both the control group and group 8, regarding )blood pressure and ECG( in group 6 and )blood pressure, ECG and ABG( in group 7. Co-administration of L-carnitine and ILE together with verapamil in group 8 showed significant improvement of all toxic parameters with insignificant difference with the control group. In conclusion, this study proved that the combined use of L-carnitine and ILE was the most effective treatment of verapamil-induced acute cardiotoxicity. Further studies are recommended on larger scale and on clinical implication to establish more the advantageous and disadvantageous of this novel therapy. It is recommended to use this novel therapy as an additive to the usual regime and when the latter fails to correct potentially fatal cases of CCB poisonings.
Highlights
Calcium channel blockers (CCB) are widely prescribed for the treatment of cardiovascular diseases and have been demonstrated to be efficacious in the management of hypertension, cardiac arrhythmias and angina
This study aimed to investigate the effectiveness of L-carnitine, as an essential compound in cellular energy production, and intralipid emulsion 20% (ILE), as an adjunctive antidote used in selected critically ill poisoned patients, for the treatment of hypotension, Electrocardiogram (ECG) changes and arterial blood gases (ABG) deficits in verapamil poisoned rats, either separately or in combination
Results: verapamil toxicity in group 5 was manifested by significant hypotension, ECG derangements in the form of bradycardia, prolongation of PR and QT intervals and ABG changes in the form of significant low
Summary
Calcium channel blockers (CCB) are widely prescribed for the treatment of cardiovascular diseases and have been demonstrated to be efficacious in the management of hypertension, cardiac arrhythmias and angina. Inotropics including glucagon and vasopressors therapy often fail to improve hemodynamic status in severely poisoned patients owing. Elawady and Saad / Ain Shams J Forensic Med Clin Toxicol, July 2015 (25):128 137 to resistance to respond secondary to underlying pathophysiology and loading complications (Shah et al, 2012; St-Onge et al, 2013). They can increase blood pressure and heart rate, but they increase systemic vascular resistance which may result in decreases in cardiac output and perfusion of vascular beds. The increased myocardial oxygen demand may be deleterious in the setting of hypotension and decreased coronary perfusion (Engebretsen et al, 2011)
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