A 56-year-old female presents to the emergency department 6h after taking an overdose of verapamil MR 120mg x 28 capsules. She has a past medical history of hypertension and atrial flutter. On admission her GCS is 15, HR 50/min, BP 100/64, Capillary blood glucose (CBG) 10.2. ECG shows sinus bradycardia with prolongation of the PR interval. You estimate her weight to be 60kg.
[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]
References
- DeRoos, F. Calcium Channel Blockers. In: Goldfrank’s Toxicologic Emergencies 9th ed. McGraw-Hill, New York 2010. Chapter 60, 884- 892.
- TOXBASE®: Verapamil [Internet] 2010 [updated 11/2008; cited 11/2010]. Available from: http://www.toxbase.org/Poisons-Index-A-Z/VProducts/Verapamil——————-/
- American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists. Position Paper: Whole Bowel Irrigation. J Toxicol Clin Toxicol. 2004; 42(6): 843-54.
- Proano, L, Chiang, WK, Wang, RY. Calcium channel blocker overdose. Am J Emerg Med. 1995; 13: 444-450.
- Boyer EW, Shannon, M. Treatment of calcium-channel-blocker intoxication with insulin infusion. N Engl J Med. 2001; 344: 1721-22.
- Salhanick, SD, Shannon, MW. Management of calcium channel antagonist overdose. Drug Saf. 2003; 26(2): 65-79.
- Bailey, B. Glucagon in β-blocker and calcium channel blocker overdoses: a systematic review. J Toxicol Clin Toxicol. 2003; 41: 595-602.
- Wolf, LR, Spadafora, MP, Otten, EJ. Use of amrinone and glucagon in a case of calcium channel blocker overdose. Ann Emerg Med. 1993; 22: 1225-8.
- Ramoska, EA, Spiller, HA, Winter, M et al. A one-year evaluation of calcium channel blocker overdoses: toxicity and treatment. Ann Emerg Med. 1993; 22: 196-200.
- Holzer, M, Sterz, F, Schoerkhuber, W, et al. Successful resuscitation of a verapamil-intoxicated patient with percutaneous cardiopulmonary bypass. Crit Care Med. 1999; 27: 2818-23.
- Durward, A, Guerguerian, AM, Lefebvre, M, Shemie, SD. Massive diltiazem overdose treated with extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2003; 4: 372-6.
- Young AC, Velez LI, Kleinschmidt KC. Intravenous fat emulsion therapy for intentional sustained-release verapamil overdose. Resuscitation. 2009; 80(5): 591-3
- Brubacher, JR. β-adrenergic antagonists. In: Goldfrank’s Toxicologic Emergencies 9th ed. McGraw-Hill, New York 2010. Chapter 61, 896- 909.
Request Permissions
To request copyright permission to republish or share portions of our works, please visit Copyright Clearance Center’s (CCC) Marketplace website by clicking the button below:
