{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T10:43:26Z","timestamp":1782902606423,"version":"3.54.5"},"reference-count":7,"publisher":"Oxford University Press (OUP)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>We report a 58-year-old Active-Duty male who developed transient, severe left ventricular dysfunction with cardiogenic shock after tizanidine ingestion, successfully managed in a forward-deployed Role 3 U.S. Army Field Hospital. This case highlights the use of multimodal macro- and micro-hemodynamic monitoring\u2014capillary refill time, urine output, lactate, central venous oxygen saturation (ScvO2), and bedside echocardiography\u2014to guide titration of vasoactive medications when right heart\/pulmonary artery catheterization was unavailable. Echocardiography was applied both qualitatively (visual ejection fraction assessment) and quantitatively (stroke volume and cardiac output estimation via left-ventricular outflow tract [LVOT] diameter and velocity\u2013time integral [VTI]). Despite profound left ventricular dysfunction and multi-drug hemodynamic dependence, cardiac function quickly normalized. This case demonstrates that advanced, physiology-guided shock resuscitation is feasible in trauma-focused, forward-deployed environments and adds to the sparse literature recognizing tizanidine-induced, reversible heart failure.<\/jats:p>","DOI":"10.1093\/milmed\/usag284","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:31:22Z","timestamp":1781004682000},"source":"Crossref","is-referenced-by-count":0,"title":["A Case Report: Tizanidine-Induced Cardiogenic Shock Managed in a U.S. Army Role 3 Field Hospital"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1232-4100","authenticated-orcid":false,"given":"Wesley M","family":"Hutto","sequence":"first","affiliation":[{"name":"US Military Hospital - Kuwait Combined Care Unit, , 10th Field Hospital (FWD) , APO, AE, 09366,","place":["Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan H","family":"Jones","sequence":"additional","affiliation":[{"name":"US Military Hospital - Kuwait Combined Care Unit, , 10th Field Hospital (FWD) , APO, AE, 09366,","place":["Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin","family":"Ortiz","sequence":"additional","affiliation":[{"name":"US Military Hospital - Kuwait Combined Care Unit, , 10th Field Hospital (FWD) , APO, AE, 09366,","place":["Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly T","family":"Davison","sequence":"additional","affiliation":[{"name":"US Military Hospital - Kuwait Emergency Department, , 10th Field Hospital (FWD) , APO, AE, 09366,","place":["Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3527-7176","authenticated-orcid":false,"given":"Tyson J","family":"Sjulin","sequence":"additional","affiliation":[{"name":"US Military Hospital - Kuwait Combined Care Unit, , 10th Field Hospital (FWD) , APO, AE, 09366,","place":["Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"2026063015305268300_usag284-B1","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1081\/clt-200026978","article-title":"Retrospective review of tizanidine (Zanaflex\u00ae) overdose","volume":"42","author":"Spiller","year":"2004","journal-title":"J Toxicol Clin Toxicol"},{"key":"2026063015305268300_usag284-B2","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1345\/aph.19257","article-title":"Hypertensive crisis and myocardial infarction following massive clonidine overdose","volume":"34","author":"Frye","year":"2000","journal-title":"Ann Pharmacother"},{"key":"2026063015305268300_usag284-B3","doi-asserted-by":"publisher","first-page":"3215","DOI":"10.1016\/s0735-1097(23)03659-8","article-title":"Escape of the octopus - tizanidine-induced reverse takotsubo cardiomyopathy","volume":"81","author":"Rouzbehani","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2026063015305268300_usag284-B4","doi-asserted-by":"publisher","first-page":"e70696","DOI":"10.7759\/cureus.70696","article-title":"Emergency response to tizanidine overdose: a case report on critical care strategies","volume":"16","author":"Morgom","year":"2024","journal-title":"Cur\u0113us (Palo Alto, CA)"},{"key":"2026063015305268300_usag284-B5","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1001\/jama.2019.0071","article-title":"Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock: the ANDROMEDA-SHOCK randomized clinical trial","volume":"321","author":"Hern\u00e1ndez","year":"2019","journal-title":"JAMA"},{"key":"2026063015305268300_usag284-B6","doi-asserted-by":"publisher","first-page":"100504","DOI":"10.1016\/j.ahjo.2025.100504","article-title":"Can utilization of the venous-to-arterial carbon dioxide difference improve patient outcomes in cardiogenic shock? A narrative review","volume":"50","author":"H\u00f8rsdal","year":"2025","journal-title":"Am Heart J Plus"},{"key":"2026063015305268300_usag284-B7","doi-asserted-by":"publisher","first-page":"345","DOI":"10.55633\/s3me\/E025.2023","article-title":"A possible role for the venous-to-arterial CO2 difference in cardiogenic shock: an exploratory study","volume":"35","author":"L\u00f3pez-Sobrino","year":"2023","journal-title":"Emergencias"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag284\/68657009\/usag284.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag284\/68657009\/usag284.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T09:44:08Z","timestamp":1782899048000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag284\/8722464"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,30]]},"references-count":7,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag284","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,30]]},"article-number":"usag284"}}