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Plasmapheresis in life-threatening verapamil intoxication
U Kuhlmann1, H Schoenemann, T Müller
1Clinic of Internal Medicine, Department of Nephrology, Philipps-University Marburg, Germany.
Artificial Cells, Blood Substitutes, and Immobilization Biotechnology
|September 29, 2000
Summary
Severe verapamil poisoning can be fatal. Early plasmapheresis significantly improved cardiovascular stability in two patients by reducing verapamil levels, offering a potential life-saving treatment option.
Area of Science:
- Cardiology
- Toxicology
- Nephrology
Background:
- Verapamil intoxication presents a life-threatening emergency with high mortality.
- Severe poisoning can lead to profound hypotension and bradycardia, necessitating advanced life support.
Observation:
- Two patients with massive oral verapamil overdose (2.4g and 9.6g) experienced severe cardiovascular compromise.
- Plasmapheresis initiated within 4 hours of ingestion appeared to reduce verapamil plasma concentrations by over 40%.
Findings:
- Dramatic improvement in cardiovascular stability was observed during plasmapheresis.
- In-vitro studies confirmed verapamil removal via plasmapheresis with a clearance of 29.2 ml/min at a blood flow of 200 ml/min.
- Extracorporeal detoxification effectively reduced verapamil-related life-threatening symptoms.
Implications:
- Early, aggressive gut decontamination and hemodynamic management are crucial for verapamil poisoning.
- Plasmapheresis serves as a viable adjunctive therapy to stabilize patients and bridge to hepatic detoxification when other methods fail.