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06:59
A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Even 'safe' medications need to be administered with care
Nancy Lutwak1, Mary Ann Howland, Rosemarie Gambetta
1Department of Emergency Medicine, VA New York Harbor Healthcare Center, NYU School of Medicine, New York, New York, USA. nancy.lutwak@gmail.com
BMJ Case Reports
|January 4, 2013
Summary
A patient with liver cirrhosis experienced lidocaine toxicity after an echocardiogram. This highlights the need for reduced lidocaine dosages in patients with chronic liver disease to prevent adverse central nervous system effects.
Area of Science:
- Pharmacology
- Toxicology
- Gastroenterology
Background:
- Transesophageal echocardiogram is a common procedure.
- Lidocaine is a widely used local anesthetic and antiarrhythmic agent.
- Patients with hepatic cirrhosis have impaired drug metabolism.
Observation:
- A 60-year-old man with hepatic cirrhosis and cardiomyopathy received topical lidocaine for a transesophageal echocardiogram.
- The patient developed transient ataxia and diplopia during recovery, indicative of lidocaine toxicity.
- The total administered dose of lidocaine was at least 280 mg via viscous solution, gargle, and ointment.
Findings:
- Oral lidocaine undergoes significant first-pass metabolism, influenced by liver blood flow.
- Impaired hepatic function in cirrhosis can lead to reduced lidocaine clearance.
- The patient's symptoms were mild and transient, suggesting a manageable level of toxicity.
Implications:
- Patients with chronic liver disease require reduced dosages of orally administered drugs with high hepatic extraction ratios.
- Careful administration and dose adjustment of lidocaine are crucial in patients with compromised liver function.
- Even commonly used medications can cause adverse effects if not administered cautiously in specific patient populations.
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