Citation

Ekemen S, Yelken B, Güleç S, Tanriverdi B. Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi 2006; 12(3): 124-127.

Copyright

(Copyright © 2006)

DOI

unavailable

PMID

unavailable

Abstract

We report here on a 58-year old man who ingested 20 tablets (180 mg verapamil and 2 mg trandolapril in each tablet) with 100 mL beer in a suicide attempt. He was brought to the emergency department of our hospital 3 hour after ingestion. On arrival, he was awake and well oriented. He was in sinus rhythm with a pulse rate of 80 beat min-1, respiration rate 20 min-1 and arterial blood pressure of 70/30 mmHg. Fluid administration with normal saline was begun. Dopamine infusion was initiated (10 μgkg-1 min-1) and 10 mL calcium chlorid 10% was given in 5 minute. But his blood pressure did not increase. Because of persistent hypotension, dobutamine and adrenaline infusions were added (10 μgkg-1 min-1 and 0.1 μgkg-1 min-1 respectively). After 2 hour of admission, cardiac monitoring revealed sinus bradicardia (40 beat min-1) and 1 mg atropine was given. While this management, second degree heart block was developed and transvenous pacing device was inserted. However, arterial blood pressure remained low at 50/30 mmHg. Central venous pressure was measured 8 cmH2O in admission. After the 2500 mL normal saline infusion completed it was measured 12 cmH2O. Normal saline, inotropic agent and calcium doses were increased, but this management was failed to increase arterial blood pressure. An intra-aortic balloon pump was inserted via right femoral artery and support rate of 1:2 was set. Haemodynamic stabilization was achived with use of an intra-aortic balloon pump and arterial blood pressure increased to 95/40 mmHg. Balloon pump support, transvenous pacing and inotropic support was terminated at 40th hr, 5th day and 2nd day respectively. He was discharged from hospital with a good prognosis at 10th day. In this case we aimed to discuss some clinical features and outcomes of different therapoetic modalities in verapamil overdose. This case suggests there is a role for intra-aortic balloon pump support in severe verapamil overdose if other medical interventions was failed to increase blood pressure.

Language: tr

Keywords

adult; human; male; case report; suicide attempt; drug overdose; article; drug intoxication; fluid therapy; hemodynamics; hypotension; atropine; adrenalin; Toxicity; dobutamine; Calcium channel blocker; Hypotension; heart block; inotropic agent; aorta balloon; arterial pressure; central venous pressure; heart atrium pacing; Inotropic support; Intra-aortic balloon pump; sinus bradycardia; trandolapril plus verapamil