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Severe atenolol and diltiazem overdose
C P Snook1, K Sigvaldason, J Kristinsson
1Department of Emergency Medicine, Iceland Poison Information Centre, Reykjavik Hospital. CurtisS@shr.is
Journal of Toxicology. Clinical Toxicology
|February 24, 2001
Summary
A massive overdose of atenolol and diltiazem caused severe cardiovascular toxicity. Phenylephrine addition to aggressive therapy successfully treated oliguria without dialysis, enabling patient survival.
Area of Science:
- Cardiology
- Clinical Pharmacology
Background:
- Combined overdose of beta-blockers (atenolol) and calcium channel blockers (diltiazem) can lead to severe cardiovascular toxicity.
- Management of such overdoses presents significant clinical challenges due to multifaceted hemodynamic compromise.
Observation:
- A case of a male patient experiencing massive combined atenolol and diltiazem overdose is presented.
- Initial resuscitation from cardiac arrest was achieved, but subsequent bradycardia, hypotension, and oliguria were resistant to standard interventions including pacing and various pharmacologic agents.
- High serum levels of both atenolol (35 microg/mL) and diltiazem were detected post-treatment.
Findings:
- Severe cardiovascular toxicity, including refractory bradycardia, hypotension, and oliguria, occurred following the overdose.
- Addition of phenylephrine to a regimen of transvenous pacing, inotropic, and pressor support was crucial in restoring adequate mean arterial pressure and urine output.
- The patient survived the overdose and hospital course, despite complications including myocardial infarction and pneumonia.
Implications:
- This case highlights the potential for severe, life-threatening cardiovascular effects from combined atenolol and diltiazem overdose.
- Phenylephrine, in conjunction with aggressive supportive care, can be an effective treatment for oliguria in severe beta-blocker overdose, potentially avoiding the need for hemodialysis.
- The reported high atenolol level associated with survival provides valuable data for understanding the toxicodynamics and management of extreme beta-blocker exposures.