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[Antiadrenergic rescue therapy with amiodarone in children with severe left ventricular dysfunction secondary to
Justo J Santiago1, Carmen A Mazzei de Dávila, Diego F Davila
1Instituto de Investigaciones Cardiovasculares, Universidad de los Andes, Mérida, Venezuela. justos@ula.ve
Insights
This study evaluated a rescue protocol for children with scorpion envenomation and left ventricular dysfunction. The protocol, including amiodarone, effectively improved cardiac function and reduced sympathetic activation.
Area of Science:
- Pediatric Cardiology
- Toxicology
- Critical Care Medicine
Context:
- Scorpion envenomation in children can cause significant sympathetic nervous system activation.
- This activation frequently leads to impaired left ventricular systolic function.
- Severe cases require immediate and effective intervention to prevent adverse outcomes.
Purpose:
- To assess the efficacy of a specific rescue protocol for managing severe left ventricular dysfunction in pediatric scorpion envenomation.
- To evaluate the protocol's impact on cardiac function markers and sympathetic activity.
Summary:
- A rescue protocol involving endotracheal intubation, mechanical ventilation, and specific intravenous medications (Dobutamine, Amiodarone, Furosemide) was administered to four children with severe left ventricular dysfunction post-scorpion envenomation.
- Cardiac function (ejection fraction) and serum levels of norepinephrine and troponin I were monitored over 48 hours.
- The protocol demonstrated significant improvements in ejection fraction and reductions in norepinephrine and troponin I levels within 48 hours.
Impact:
- The findings suggest that this rescue protocol can effectively manage acute left ventricular dysfunction in pediatric scorpion envenomation.
- Amiodarone's role as a neuromodulator in decreasing norepinephrine levels is highlighted.
- This research provides a potential therapeutic strategy for a life-threatening condition in children.
Background:
Children with scorpion envenomation have massive sympathetic activation and variable degrees of left ventricular systolic dysfunction.
Objective:
To evaluate a rescue protocol for children with severe left ventricular dysfunction secondary to scorpion envenomation.
Methods:
Four children, after scorpion envenomation, were subjected to a rescue protocol for acute left ventricular dysfunction: Endotracheal intubation and respiratory assistance, electrocardiograms, chest x-Ray, echocardiograms and blood samples for norepinephrine and troponin I serum levels. Samples and echocardiograms were repeated at 12, 24 and 48 hours. Intravenous medications: Dobutamine: 4-6 microg/kg/min. Amiodarone: 3 mg/kg during a 2 hour period. Maintenance: 5 mg/kg/day. Furosemide: 0.5 mg/kg/dose. Diuretics were given when the systemic blood pressure was above percentile fifty. Amiodarone, Dobutamine and Furosemide were administered during the first 48 hours. Beta-adrenergic blockers and angiotensin converting enzyme were given, at 48 hours after admission, once the left ventricular Ejection fraction > 0.35 and the clinical status had improved.
Results:
On admission, norepinephrine was 1,727.50 +/-794.96 pg/ml, troponin I 24.53 +/- 14.09 ng/ml and left ventricular ejection fraction 0.20 +/- 0.056. At twelve hours, norepinephrine and troponin I serum levels were down to half of the initial values and the ejection fraction increased to 0.32 +/- 0.059. During the next 24 and 48 hours, the ejection fraction rose to 0.46 +/- 0.045, (p<0.01) and norepinephrine and troponin diminished to 526.75 +/- 273.73 (p < 0.02) and 2.20 +/- 2.36 (p<0.02) respectively.
Conclusion:
Amiodarone, by acting as a neuromodulator, is very likely responsible for the early and progressive decrease of serum norepinephrine.
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