Case report: cocaine cardiotoxicity treated with intravenous lipid infusion
December 10, 2012, 11:59 pm
Usefulness of Intravenous Lipid Emulsion for Cardiac Toxicity from Cocaine Overdose. Arora NP et al. Am J Cardiol 2012 Nov 24. [Epub ahead of print]
This case report describes a 26-year-old man who developed status epilepticus, tachycardia, and hypotension after smoking a “large amount” of crack cocaine. EKG showed a wide-complex tachycardia (QRS = 148 msec) with a prolonged corrected QT interval (595 msec). The prolonged intervals did not respond to sodium bicarbonate (although the patient apparently received only 50 mEq over 10 min) or magnesium sulfate.
The treating physicians reasoned that since cocaine is a lipophilic local anesthetic, administering intravenous lipid emulsion might be beneficial. He received an infusion of 100-ml 20% Intralipid. The authors report that “[w]ithin 10 minutes of starting the ILE infusion” the patients QRS narrowed and his blood pressure improved.
This is an interesting case report, but of course only a case report. To my knowledge, there is only one previous report of intralipid being used to treat cocaine toxicity. Unfortunately, there is not much discussion about the non-lipid aspects of management in this case. It seems to me that the dose of bicarbonate was remarkably tiny and given too slowly, and that the use of phenytoin to control toxic seizure activity was ill-advised.