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Related Experiment Videos

Diltiazem overdose: case report and review.

F C Erickson1, L J Ling, G A Grande

  • 1Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.

The Journal of Emergency Medicine
|September 1, 1991
PubMed
Summary

This case report details a massive diltiazem overdose (4.2 grams) where the patient recovered without advanced interventions. Review of diltiazem overdose cases suggests effective management strategies for emergency physicians.

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Clinical Toxicology

Background:

  • Diltiazem is a calcium channel blocker used to treat hypertension and angina.
  • Overdoses can lead to severe cardiovascular compromise.

Observation:

  • A patient ingested 4.2 grams of diltiazem, presenting with profound hypotension (60/40 torr) and bradycardia (62 bpm) in a junctional rhythm.
  • Initial management included activated charcoal, gastric lavage, IV fluids, calcium, dopamine, and atropine, leading to vital sign improvement.

Findings:

  • This case represents one of the largest reported diltiazem ingestions.
  • The patient recovered without the need for cardiac pacing or other extraordinary measures.
  • A review of eight prior diltiazem overdose cases indicates successful recovery within 48 hours with interventions like pressors, calcium, glucagon, pacing, and charcoal hemoperfusion.

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Implications:

  • This case highlights the potential for recovery even in massive diltiazem overdoses.
  • A structured approach for emergency physicians managing diltiazem toxicity is proposed.
  • Early and appropriate interventions are crucial for favorable outcomes in calcium channel blocker overdoses.