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Unexpected hypotension in catecholamine reversal: a case report.

Yohei Okada1, Wataru Ishi2, Hiromichi Narumiya2

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In a rare case, catecholamine agents caused unexpected hypotension due to risperidone

Keywords:
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Area of Science:

  • Critical Care Medicine
  • Clinical Pharmacology

Background:

  • Catecholamine agents are vital for circulatory support.
  • Unexpected hypotension can occur with catecholamine use in specific circumstances.

Observation:

  • A patient with schizophrenia presented in shock and coma after ingesting risperidone.
  • Catecholamine infusion led to severe hypotension (59/40 mmHg).
  • Vasopressin administration stabilized the patient's blood pressure.

Findings:

  • The hypotension was attributed to risperidone's alpha-adrenergic blockade, causing 'catecholamine reversal'.
  • This phenomenon mirrors 'adrenaline reversal' seen in animal studies.
  • Vasopressin proved effective due to its distinct mechanism of action.

Implications:

  • Recognizing 'catecholamine reversal' is crucial when hypotension occurs despite catecholamine administration.
  • Suspect alpha-adrenergic antagonist effects, like those from risperidone overdose.
  • Consider vasopressin as a preferred alternative in such critical situations.