From the Guidelines
Cardiogenic shock is the type of shock most commonly associated with adverse effects of medications or overdoses, particularly those that depress heart function such as beta-blockers and calcium channel blockers. This severe form of shock can occur when the body's heart is unable to pump enough blood to meet its needs, often due to the toxic effects of certain medications. Common medications that can trigger cardiogenic shock include beta-blockers, calcium channel blockers, and certain anti-arrhythmic drugs like sodium channel blockers 1. Additionally, drug overdoses, particularly with medications like opioids, can cause distributive or cardiogenic shock through different mechanisms. For instance, beta-blocker overdose can lead to cardiogenic shock by severely depressing heart function, while opioid overdose can cause distributive shock through vasodilation.
Key Points to Consider
- The management of cardiogenic shock due to medication overdose or adverse effects involves stopping the offending drug, providing supportive care, and in some cases, specific antidotes like glucagon for beta-blocker toxicity or naloxone for opioid overdose 1.
- The use of extracorporeal support, including VA-ECMO, has been used successfully in patients with refractory cardiogenic shock from sodium channel blocker poisoning, although controlled observational studies and clinical trial data do not exist 1.
- A multidisciplinary approach to diagnosis and management, utilizing standardized protocols that emphasize early invasive hemodynamics and team-based care, may improve clinical outcomes in patients with cardiogenic shock 1.
Treatment Approach
- Treatment depends on the specific medication involved and the severity of the shock.
- Stopping the offending drug and providing supportive care are crucial steps in managing cardiogenic shock due to medication overdose or adverse effects.
- Specific antidotes, such as glucagon for beta-blocker toxicity or naloxone for opioid overdose, may be necessary in some cases.
- The use of extracorporeal support, including VA-ECMO, may be considered in patients with refractory cardiogenic shock due to sodium channel blocker poisoning.
From the FDA Drug Label
The fatal adult dose of atropine is not known. In pediatric populations, 10 mg or less may be fatal. In the event of toxic overdosage, a short acting barbiturate or diazepam may be given as needed to control marked excitement and convulsions Prolonged administration of any potent vasopressor may result in plasma volume depletion which should be continuously corrected by appropriate fluid and electrolyte replacement therapy If plasma volumes are not corrected, hypotension may recur when LEVOPHED is discontinued, or blood pressure may be maintained at the risk of severe peripheral and visceral vasoconstriction (e.g., decreased renal perfusion) with diminution in blood flow and tissue perfusion with subsequent tissue hypoxia and lactic acidosis and possible ischemic injury.
The type of shock associated with adverse effects of medications or overdoses is hypotensive shock or circulatory collapse, which may occur due to severe intoxication with medications like atropine 2 or due to plasma volume depletion caused by potent vasopressors like norepinephrine 3.
From the Research
Type of Shock Associated with Adverse Effects of Medications or Overdoses
- Cardiogenic shock is associated with adverse effects of medications or overdoses, particularly with the use of β-blockers and calcium channel blockers 4, 5.
- This type of shock can occur due to the combination therapy of β-blockers and non-dihydropyridine calcium channel blockers, or individual administration in patients with high myocardial susceptibility and vulnerability 4.
- Intentional ingestions of calcium-channel blockers and beta blockers can also lead to cardiogenic shock, which can be treated with high-dose insulin and intravenous lipid emulsion therapy 5.
Treatment of Cardiogenic Shock
- Treatment options for cardiogenic shock include the administration of intravenous calcium, glucagon, or high-dose insulin 4.
- High-dose insulin and intravenous lipid emulsion therapy have emerged as effective treatment options for severe toxicity from calcium-channel blocker and beta blocker overdose 5.
- Inotropes and vasopressors are widely used to improve hemodynamics acutely, but reliable information regarding comparative efficacy of individual agents is lacking 6.