Ventricular Tachycardia Storm Induced by Loperamide Abuse
Jihad Al-Khatib1, Shravani R Vindhyal1, Venkata S Boppana2
1Internal Medicine, University of Kansas School of Medicine, Wichita, USA.
Cureus
|April 11, 2019
Summary
High doses of the anti-diarrheal loperamide can cause dangerous ventricular arrhythmias, including ventricular tachycardia storms. Clinicians must recognize this risk, especially amid the opioid crisis, as loperamide has opioid-like side effects.
Area of Science:
- Cardiology
- Clinical Pharmacology
- Toxicology
Background:
- Recent reports indicate an increased incidence of ventricular arrhythmias linked to high-dose loperamide consumption.
- Loperamide, an over-the-counter anti-diarrheal, possesses opioid-like properties and potential for misuse.
- The opioid crisis necessitates awareness of all substances with opioid-like side effects.
Observation:
- A unique case involving a patient presenting with sustained ventricular tachycardia (VT), also known as a VT storm.
- This presentation occurred following the consumption of large dosages of loperamide.
Findings:
- The patient experienced life-threatening ventricular arrhythmias, specifically a VT storm.
- This highlights a severe cardiac complication associated with supra-therapeutic loperamide use.
Implications:
- Clinicians must be aware of the potential for severe cardiac toxicity from high-dose loperamide.
- This underscores the importance of considering all medications, including over-the-counter drugs, with opioid-like side effects in the context of the current opioid crisis.
Related Concept Videos
01:15Drug Abuse and Addiction: Pharmacological Phenomena
1.2K
Drug dependence, abuse, and addiction are complex phenomena that can precipitate various abnormal states. Physical dependence refers to a state of pharmacological adaptation to a drug. This adaptation often results in tolerance—a reduced response to the drug after repeated administrations. When the drug use is abruptly stopped, withdrawal symptoms occur due to the body's need to readjust from the pharmacologically induced imbalance. However, tolerance and withdrawal symptoms do not...
1.2K
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
516
Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
516
01:13Induced-fit Model
89.0K
Most chemical reactions in cells require enzymes—biological catalysts that speed up the reaction without being consumed or permanently changed. They reduce the activation energy needed to convert the reactants into products. Enzymes are proteins, that usually work by binding to a substrate—a reactant molecule that they act upon.
Enzymes exhibit substrate specificity, meaning that they can only bind to certain substrates. This is mainly determined by the shape and chemical...
Enzymes exhibit substrate specificity, meaning that they can only bind to certain substrates. This is mainly determined by the shape and chemical...
89.0K
01:13Induced Pluripotent Stem Cells
27.3K
Stem cells are undifferentiated cells that divide and produce different types of cells. Ordinarily, cells that have differentiated into a specific cell type are post-mitotic—that is, they no longer divide. However, scientists have found a way to reprogram these mature cells so that they “de-differentiate” and return to an unspecialized, proliferative state. These cells are also pluripotent like embryonic stem cells—able to produce all cell types—and are therefore...
27.3K
01:30Spontaneous and Induced Mutations
2.2K
Spontaneous mutations arise infrequently during DNA replication due to errors in the process. A key factor behind these errors is tautomeric shifts in nitrogenous bases, where bases transition from keto to enol forms or amino to imino forms. This shift can alter base-pairing rules, leading to mutations. Additionally, reactive oxygen species (ROS) arising from aerobic metabolism can damage DNA, resulting in depurination (loss of a purine base) or depyrimidination (loss of a pyrimidine base).
2.2K
01:28Induced Electric Dipoles
4.7K
A permanent electric dipole orients itself along an external electric field. This rotation can be quantified by defining the potential energy because the external torque does work in rotating it. Then, the potential energy is minimum at the parallel configuration and maximum at the antiparallel configuration. While the former is a stable equilibrium, the latter is an unstable equilibrium.
Since the absolute value of potential energy holds no physical meaning, its zero value can be chosen as per...
Since the absolute value of potential energy holds no physical meaning, its zero value can be chosen as per...
4.7K