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Massive diltiazem overdose treated with extracorporeal membrane oxygenation
Andrew Durward1, Anne-Marie Guerguerian, Marc Lefebvre
1Pediatric Critical Care Unit, Hospital for Sick Children, Toronto, Canada.
Summary
A massive diltiazem overdose in a teen was successfully treated with aggressive supportive care, including extracorporeal membrane oxygenation. This case highlights the reversibility of severe calcium channel blocker toxicity with prompt medical intervention.
Area of Science:
- Cardiology
- Toxicology
- Critical Care Medicine
Background:
- Calcium channel blockers, like diltiazem, are widely prescribed for cardiovascular conditions.
- Overdoses can lead to severe toxicity, including profound hypotension and cardiac dysfunction.
Observation:
- A 16-year-old presented after ingesting 12g of sustained-release diltiazem, experiencing refractory hypotension and cardiac arrest.
- The patient required extracorporeal membrane oxygenation for 48 hours due to atrial standstill and developed multiorgan dysfunction.
Findings:
- Plasma diltiazem levels showed a prolonged half-life (28-48 hours), with limited effectiveness of charcoal hemoperfusion.
- Aggressive supportive therapy, including glucagon, epinephrine, calcium, and extracorporeal membrane oxygenation, was crucial for recovery.
Implications:
- Massive diltiazem overdose can cause severe, prolonged multiorgan dysfunction.
- Early and aggressive supportive care, especially cardiovascular support, is critical for managing calcium channel blocker toxicity.
- Even in severe cases, toxic effects of calcium channel blockers may be reversible with intensive treatment.