Related Experiment Video
Updated: Aug 15, 2026

Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Fatal unintentional overdose of diltiazem with antemortem and postmortem values
F Lee Cantrell1, Saralyn R Williams
1California Poison Control System, San Diego Division, San Diego, California 92103-8925, USA. fcantrel@ucsd.edu
Background:
Therapeutic errors involving calcium channel antagonists (CCA) resulting in death rarely have been reported in detail. We report a fatality from an unintentional overdose of sustained-release (SR) diltiazem including antemortem and postmortem blood concentrations.
Case Report:
A 65-year-old man with aortic stenosis mistakenly took six tablets of diltiazem 360 mg SR. He developed symptoms of toxicity by 7 hours after ingestion. By 10 hours, he went to the emergency department. Despite a prolonged resuscitative attempt, the patient died 17 hours postingestion. An antemortem blood sample drawn 11.5 hours after ingestion was 2.9 mcg/mL. Postmortem gas chromatography of central blood revealed a diltiazem level of 6 mcg/mL and the peripheral blood sample measured 5 mcg/ mL.
Conclusion:
This case suggests that an unintentional overdose with a CCA may be lethal if the patient's cardiovascular ability to compensate for the toxic effects is compromised.
Related Concept Videos
Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
Drug Toxicity: Dose-Dependent Reactions
Drug Toxicity: Risk factors
Drug Toxicity: Overview
Cardiopulmonary Resuscitation IV: Pharmacological Management
Coronary Artery Disease III: Clinical Manifestations
