Amiodorone Toxicity

heart queen · Feb 5, 2004

gosh-darned it noooo and now I want to know what it is too!

Dinith88 · Feb 5, 2004

Don,

I've personally taken care of 2 such patients. If i remember correctly, they were treated w/steroids and bronchodilators....much like a COPD/fibrosis patient. And i think an antibiotic was in the mix as well.... because of the possibility of a co-existing pneumonia. Also, there are varying degrees of lung toxicity so different patients will be treated accordingly. I do know that it's a progressive 'thing' that takes time to develope and wont spring up over night. The diagnosis is usually one of exclusion as the pt's CXR can mimic other pathologies. If the pt already has an advanced copd and/or fibrosis, it'll probably spell doom for the unfortunate fellow as it could easily be missed.

I beleive that once a patient developes amiodarone induced pulmonary fibrosis, they'll have it for the rest of their life...which sucks. Luck of the draw i suppose.

MarkHammerschmidt · Feb 5, 2004

Yeah, we've seen it too. Something like 5% of folks rx'd with Amio develop this, and I think it doesn't go away. Roids, abx maybe, not sure. Bad.

donnuchi · Feb 5, 2004

Actually, I am an NICU RN. The patient with Amiodorone toxicity is my Dad. He has been in the ICU for nearly 5 weeks. He was on the drug for 10 months. I guess he had developed a dry cough over 2 months and then on New Year's Eve started feeling sick. We thought he was getting the flu. Over the next few days he was feeling worse and then on 1/3 woke up very short of breath. He went to the doctor and the x-ray looked like bilateral pneumonia. His sats were in the low 80s so he was admitted into the hospital. He was on a non-rebreather mask for 2 weeks. After the first week they did a lung biopsy showing diffuse alveolar damage. After the second week, he was so tired out that his CO2s started to climb and he was intubated. He was on high pressures and developed subcutaneous emphysema, pneumoperitoneum and pneumopericardium. They changed him to a low tidal volume protocol that was developed by the ARDS Network and he hung in there! They had to paralyze him because he could not tolerate a rate of 35. That was 2 1/2 weeks ago. He made it down to 50% and a PEEP of 5 and last night took him off the vecuronium. He is just starting to move a bit, so I guess we will see what happens over the next few days. What do you think are his chances of getting off the ventilator? How can the doctors tell how much fibrosis is there if the x-ray continues to say bilateral infiltrates? Thanks for the information.

Dinith88 · Feb 5, 2004

Don, i hope your dad does well, it's gotta be a hard time for you and your family.

As far as estimating how much fibrosis he's developed, they may be able to give you a good 'guess' based on cxr/ct, etc. but it'll only be a guesstimation.

Sounds as though he's making progress as far as coming off the vent. Once off, the pulmonologist will probably look more at Pulmonary Function Tests to determine his lungs' various capacities. It's probably still too early to tell how much damage his lungs have sustained, although it sounds extensive as he's developed respiratoy failure. Only time will tell.

mittels · Feb 6, 2004

Yes, I have diffently seen it. Scares the h@#! out of a person.

The pt I took care of was completely blue. No joke!!!

skin, nails, whites of eyes, lips purple. If you ever see it youll never forget it. The toxicity and skin color never returns to normal.