Abstract
Objective
Meprobamate self-poisoning has been reported as potentially inducing hypotension. We examined the incidence and causes of hypotension induced by this poisoning and its prognosis.
Design and setting
Retrospective observational study conducted in a medical ICU between June 1997 and October 2003. Seventy-four patients admitted for meprobamate poisoning and needing mechanical ventilation were included. Demographic, clinical, and laboratory data were compared between patients with and without hypotension. All echocardiograms recorded in patients with hypotension were reviewed, and left ventricular (LV) and right ventricular (RV) functions were assessed.
Results
Twenty-nine (40%) patients exhibited hypotension without any significant difference in age, gender, cardiac history, or meprobamate concentration in blood when compared to patients without hypotension. Base excess was significantly lower in patients with hypotension. Echocardiography demonstrated a hypokinetic state, associating decreased LV ejection fraction (45±15%) and cardiac index (2±0.7 l min−1 m−2), and increased inferior vena cava diameter. Most patients with hypotension received inotropic drugs by infusion, and were ventilated for significantly longer.
Conclusions
Meprobamate self-poisoning induces hypotension, notably related to cardiac failure, in about 40% of cases. This has important therapeutic consequences, as frequent inotropic drug infusion. The mechanisms of cardiac toxicity remain largely unknown, and no predictive factor could be isolated.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Collee GG, Hanson GC (1993) The management of acute poisoning. Br J Anaesth 705:562–573
Jaeger A, Flesch F (1999) Les intoxications aiguës: épidémiologie, diagnostic et traitements. In: Jaeger A, Vale JA (ed) Intoxications aiguës. Elsevier, Paris, pp 13–37
Isbister GK, Downes F, Sibbritt D, Dawson AH, Whyte IM (2004) Aspiration pneumonitis in an overdose population: frequency, predictors, and outcomes. Crit Care Med 321:88–93
Bismuth C, Baud FJ, Conso F, Frejaville JP, Garnier R (1987) Toxicologie clinique. In: C Bismuth (ed) Toxicologie clinique. Flammarion, Paris
Allen AG, Black AV (1956) Near-fatal case of intoxication with meprobamate treated with electro-stimulation and levarterenol. Ohio Med 5212:1303
Allen MD, Greenblatt DJ, Noel BJ (1977) Meprobamate overdosage: a continuing problem. Clin Toxicol 115:501–515
Gaultier M, Fournier E, Bismuth C, Rapin J, Frejaville JP, Gluckman JC (1968) Acute poisoning by meprobamate. A propos of 141 cases. Bull Mem Soc Med Hop Paris 1198:675–705
Landier C, Lanotte R, Legras A, Dequin PF, Perrotin D (1994) State of shock during acute meprobamate poisoning. 6 cases. Ann Fr Anesth Reanim 133:407–411
Schwartz HS (1976) Acute meprobamate poisoning with gastrotomy and removal of a drug-containing mass. N Engl J Med 29521:1177–1178
Jardin F, Bourdarias JP (1995) Right heart catheterization at bedside: a critical view. Intensive Care Med 214:291–295
Lhoste F, Lemaire F, Rapin M (1977) Treatment of hypotension in meprobamate poisoning. N Engl J Med 296:1004
Taboulet P, Bismuth C (1994) Shock caused by poisoning. Use of cardiotropic agents. Presse Med 2327:1263–1268
Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F (2003) Hemodynamic instability in sepsis: bedside assessment by Doppler echocardiography. Am J Respir Crit Care Med 16811:1270–1276
Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F (2002) Echo-Doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med 16610:1310–1319
Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, Teres D (1996) The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA 27610:802–810
Triulzi M, Wilkins G, Giliam L, Gentile L, Weyman A (1985) Normal adult crosssectional echocardiography values: left ventricular volume. Echocardiography 2:153–169
Weyman (1982) Cross sectionnal echocardiography. Fibiger & Lea, Philadelphia, pp 501–502
Barbier C, Loubieres Y, Jardin F, Vieillard-Baron A (2004) Author’s reply to the comment by Dr. Bendjelid. Intensive Care Med 309:1848
Eeckhout E, Huyghens L, Loef B, Maes V, Sennesael J (1988) Meprobamate poisoning, hypotension and the Swan-Ganz catheter. Intensive Care Med 144:437–438
Longchal J, Tenaillon A, Trunet P, Labrousse J, Lissac J (1978) Meprobamate poisoning with cardiac insufficiency. Treatment with dobutamine. Nouv Presse Med 716:1408–1409
Axelson JA, Hagaman JF (1977) Meprobamate poisoning and pulmonary edema. N Engl J Med 296:1481
Weil M, Von Planta M, Rackow E (1992) Treatment of cardiogenic shock. In: Braunwald E (ed) Heart disease. Saunders, Philadelphia, p 1254
Kintz P, Tracqui A, Mangin P, Lugnier AA (1988) Fatal meprobamate self-poisoning. Am J Forensic Med Pathol 92:139–140
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Charron, C., Mekontso-Dessap, A., Chergui, K. et al. Incidence, causes and prognosis of hypotension related to meprobamate poisoning. Intensive Care Med 31, 1582–1586 (2005). https://doi.org/10.1007/s00134-005-2816-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-005-2816-9