NDLI: Vasoplegic Shock Treated with Methylene Blue Complicated by Severe Serotonin Syndrome.

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Vasoplegic Shock Treated with Methylene Blue Complicated by Severe Serotonin Syndrome.

Content Provider	Europe PMC
Author	Chan, Betty S. Becker, Therese Chiew, Angela L. Abdalla, Ahmed M. Robertson, Tom A. Liu, Xin Roberts, Michael S. Buckley, Nicholas A.
Abstract	Introduction Management of severe vasoplegic shock in overdose can be very challenging. We describe a case of severe refractory vasodilatory shock in poisoning where methylene blue (MB) was used with success. However, the patient subsequently developed severe Serotonin Syndrome (SS) as a result of an interaction between serotonergic drugs and MB. Case Report A 15-year-old male developed severe vasoplegic shock 1.5 hours after overdosing on several different medications including quetiapine slow release, quetiapine immediate release, desvenlafaxine slow release, venlafaxine, amlodipine, ramipril, fluoxetine, promethazine and lithium. His vasoplegic shock was resistant to high doses of noradrenaline and vasopressin. MB was administered 6.5 hours post ingestion and within 1 hour there was an improvement in his hemodynamic status and reduction of catecholamine requirements. Twelve hours post ingestion, he developed severe Serotonin Syndrome that lasted 5 days as a result of interaction between MB, a reversible monoamine oxidase inhibitor (MAO-I), and the antidepressants taken in overdose. MB had a calculated half-life of 38 hours. Conclusion MB is a useful additional strategy for severe drug induced vasodilatory shock and may be potentially life-saving. Clinicians should be aware that it can interact with other drugs and cause life-threatening Serotonin Syndrome. Lower doses or shorter durations may be wise in patients at risk of this interaction.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC6013734&blobtype=pdf
ISSN	15569039
Volume Number	14
DOI	10.1007/s13181-017-0637-1
PubMed Central reference number	PMC6013734
Issue Number	1
PubMed reference number	29134498
Journal	Journal of Medical Toxicology [J Med Toxicol]
e-ISSN	19376995
Language	English
Publisher	Springer US
Publisher Date	2017-11-13
Publisher Place	New York
Access Restriction	Open
Rights License	© American College of Medical Toxicology 2017
Subject Keyword	Methylene blue Vasoplegic shock Overdose Serotonin syndrome
Content Type	Text
Resource Type	Article
Subject	Health, Toxicology and Mutagenesis Toxicology

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