Citation

Liang CW, Diamond SJ, Hagg DS. J. Med. Case Reports 2011; 5.

Copyright

(Copyright © 2011, Holtzbrinck Springer Nature Publishing Group - BMC)

DOI

10.1186/1752-1947-5-399

PMID

unavailable

Abstract

Introduction. Massive intentional verapamil overdose is a toxic ingestion which can cause multiorgan system failure and has no currently known antidote. Case Presentation. The patient is a 41-year-old Caucasian woman who ingested 19.2 g of sustained release verapamil in a suicide attempt. Our patient became hypotensive requiring three high-dose vasopressors to maintain arterial pressure. She also developed acute respiratory failure, bradycardic ventricular rhythm necessitating continuous transvenous pacing, and anuric renal failure. Our patient was treated with intravenous calcium, bicarbonate, hyperinsulinemic euglycemic therapy and continuous venovenous hemodialysis without success. On the fourth day after hospital admission continuous intravenous lipid therapy was initiated. Within three hours of beginning lipid therapy, our patient's vasopressor requirement decreased by half. Within 24 hours, she was on minimal vasopressor support and regained an underlying junctional rhythm. After three days of lipid infusion, she no longer required inotropic agents to maintain blood pressure or pacing to maintain stable hemodynamics.

CONCLUSIONS: Intravenous fat emulsion therapy may be an effective antidote for massive verapamil toxicity. © 2011 Liang et al; licensee BioMed Central Ltd.

Language: en

Keywords

adult; human; female; resuscitation; case report; suicide attempt; drug overdose; article; tachycardia; priority journal; noradrenalin; dopamine; activated carbon; fluid therapy; intensive care; fever; heart rate; Caucasian; adrenalin; bicarbonate; endotracheal intubation; insulin; metabolic acidosis; glucagon; abdominal distension; leukocytosis; calcium; furosemide; thorax radiography; antibiotic therapy; lethargy; heparin; oxygen saturation; drug dose reduction; vasopressin; thrombosis; verapamil; continuous hemodialysis; systolic blood pressure; drug dose increase; continuous infusion; isoprenaline; anuria; sinus bradycardia; nitric oxide; hypoxemia; calcium chloride; acute respiratory failure; ischemic colitis; colostomy; heart pacing; vancomycin; piperacillin plus tazobactam; T wave inversion; colon resection; Staphylococcus; intralipid; complete heart block; pneumatosis intestinalis; assisted ventilation; airway pressure release ventilation; cisatracurium; hyperinsulinemic euglycemic therapy