IJCS | Volume 33, Nº1, January / February 2019

DOI: 10.5935/2359-4802.20190025 98 CASE REPORT International Journal of Cardiovascular Sciences. 2020;33(1):98-101 Mailing Address: Cássio Alexandre Oliveira Rodrigues Residência Multiprofissional em Saúde, Hospital Universitário Onofre Lopes - Avenida Nilo Peçanha, 620. Postal Code: 59.012-300, Petrópolis, Natal (RN) - Brazil. E-mail: cassioalexandr3@live.com A Rare Case of Cardiorespiratory Arrest after Metoclopramide Infusion Cássio Alexandre Oliveira Rodrigue s, Eduardo Queiroz da Cunh a, P riscila Ribeiro de Paul a, R and Randall Martin s Hospital Universitário Onofre Lopes (HUOL), Universidade Federal do Rio Grande do Norte (UFRN), RN - Brazil Manuscript received May 22, 2018; revised manuscript September 24, 2018; accepted November 01, 2018. Metaclopramide/Adverse effects; Drug Prescriptions/ standards; HeartArrest; Pharmacokinetics; Drug Related Side Effects and Adverse Reactions. Keywords Introduction Commonly used as an antiemetic and prokinetic agent, especially in critically-ill patients to reverse gastroparesis and increase in gastric emptying, metoclopramide use can result in important adverse reactions, leading the European Medicines Agency to recommend its use at minimum doses and for a short period of time, due to the risk of neurotoxicity. 1 Although often associated to neurological events, reactions to this drug affecting the cardiovascular system are less frequent when compared to those that affect the central nervous system. There have been reports of total atrioventricular block 2 and sinus arrest, 3 but the occurrence of metoclopramide-induced cardiorespiratory arrest (CRA) is a rare and poorly described event. Considering the scarcityof reportsand itswidespreaduse in health services, we described a case of CRA in a 21-year- old youngwoman immediately after the administration of metoclopramide for the treatment of diabetic gastroparesis. This reportwas approvedby theResearchEthicsCommittee of HUOL (CAAE: 73091717.0.0000.5292). The free and informed consent formwas signed by the patient. Case Report This is the case of a 21-year-old female patient with type I diabetes, using analogous insulin (lispro and glargine), allergic to dipyrone and with previous use of gabapentin and amitriptyline for the treatment of chronic pain. During anamnesis, previous cardiovascular disease was not reported or evidenced. The patient was treated in an emergency unit due to diabetic ketoacidosis, triggered by poor diet and medication adherence when she developed lowering of consciousness level and bronchoaspiration episode, requiring orotracheal intubation and mechanical ventilation. After 24 hours, the patient was transferred to the intensive care unit (ICU) of our institution, showing increased nitrogenous waste, refractory to clinical measures and thus, renal replacement therapy with hemodialysis was indicated due to refractory acidosis and hypervolemia. There was no report of previous chronic kidney disease. For the treatment of aspiration pneumonia, cefepime and clindamycin were used during the first three days of hospitalization, later modified for meropenem and amikacin due to the suspicion of a new infectious condition. The patient was under continuous sedation with fentanyl and midazolam, with a Richmond agitation sedation scale (RASS) target score = 0 and required hemodynamic support with norepinephrine (0.1 mcg/kg/min) for a short period of time at the beginning of hospitalization, withdrawn on the 4 th day at the ICU. During this period, treatment with metoclopramide at a dose of 10 mg (iv, 8/8 hours) diluted in 100 mL of 0.9% sodium chloride (0.1 mg/ mL) was started for treatment of diabetic gastroparesis. Three days later, as she required greater fluid restriction, the prescription was adjusted: the saline solution was replaced by 18 mL of bidistilled water (0.5 mg/mL). The route of administration and dose were maintained. After initial clinical measures, there was a satisfactory evolution of the clinical condition with better glycemic control, regression of gastroparesis and discontinuation of hemodialysis due to sustained improvement of