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Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report

  • Toxicology Observation
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Abstract

Introduction

The purpose of this study is to describe a case where methylene blue improved hemodynamics in a poisoned patient.

Case Report

This is a single case report where a poisoned patient developed vasodilatory shock following ingestion of atenolol, amlodipine, and valsartan. Shock persisted after multiple therapies including vasopressors, high-dose insulin, hemodialysis, and 20% intravenous fat emulsion. Methylene blue (2 mg/kg IV over 30 min) was administered in the ICU with temporal improvement as measured by pulmonary artery catheter hemodynamic data pre- and post-methylene blue administration. Within 1 h of methylene blue administration, systemic vascular resistance improved (240 dyn s/cm5 increased to 1204 dyn s/cm5), and vasopressor requirements decreased with maintenance of mean arterial pressure 60 mmHg.

Discussion

Methylene blue may improve hemodynamics in drug-induced vasodilatory shock and should be considered in critically ill patients poisoned with vasodilatory medications refractory to standard therapies.

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Conflict of Interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Minnesota Poison Control System, Hennepin County Medical Center, 701 Park Avenue, Mail Code RL, Minneapolis, MN, 55415, USA

    JoAn R. Laes

  2. Hennepin County Medical Center Critical Care Fellowship, Hennepin County Medical Center, Minneapolis, MN, USA

    David M. Williams

  3. Minnesota Poison Control System, Minneapolis, MN, USA

    Jon B. Cole

Authors
  1. JoAn R. Laes
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  2. David M. Williams
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  3. Jon B. Cole
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Correspondence to JoAn R. Laes.

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Laes, J.R., Williams, D.M. & Cole, J.B. Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report. J. Med. Toxicol. 11, 460–463 (2015). https://doi.org/10.1007/s13181-015-0500-1

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