CASE REPORT article
Front. Pharmacol.
Sec. Predictive Toxicology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1669831
Successful rescue of a rare case of refractory shock due to multidrug toxicity: A case report
Provisionally accepted
- 1Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- 2Chongqing Medical University, Chongqing, China
- 3Department of Critical Care Medicine, Chongqing Medical University, Chongqing, China
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INTRODUCTION: This article reports the successful treatment experience of refractory shock, acidosis, hypoglycemia, and multi-organ failure after overdose of reserpine, enalapril, and metformin, and aims to provide a reference for the rescue of patients with such poisoning. METHODS： A 58-year-old woman with sudden disturbance of consciousness, intractable shock, severe metabolic acidosis, hypoglycemia, and multiple organ dysfunction was urgently transferred to the ICU. The blood pressure could not be maintained after massive rehydration and a large dose of vasoactive drugs. The treatment plan was adjusted quickly after the diagnosis and treatment of medicine, nephrology, cardiology, respiratory, and other disciplines, such as high-dose vasoactive drugs, pressors, continuous blood purification, plasma exchange, and hemoperfusion. RESULTS: The dose of vasoactive drugs began to decrease after entering the ICU at 36 h, and the acidosis gradually improved after 46 hours. After 72 hours, the patient was conscious and was transferred to the general ward on the 9th day. CONCLUSION: The treatment of mixed drug poisoning involving reserpine, metformin, and enalapril is very challenging. When resuscitating patients with refractory shock caused by such poisoning, early supportive therapies should be started, including gastric lavage, cathartic use, acid correction, improved ventilation, blood purification, and hemodialysis when needed. Additionally, vasoactive drugs may be given without an upper dose limit, as long as side effects are carefully monitored.
Keywords: Reserpine, Metformin-associated lactic acidosis, intractable shock, Hypoglycemia, multiple organ dysfunction, multidisciplinary diagnosis and treatment
Received: 20 Jul 2025; Accepted: 20 Aug 2025.
Copyright: © 2025 Xie, Zhou and Cao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yunxing Cao, Department of Critical Care Medicine, Chongqing Medical University, Chongqing, China
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