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Diltiazem and metoclopramide overdose.

J M Beno1, D R Nemeth

  • 1Office of the Medical Examiner, Rochester, New York 14620.

Journal of Analytical Toxicology
|September 1, 1991
PubMed
Summary

This case study details a fatal overdose of diltiazem and metoclopramide. High drug levels and cardiac complications, including asystole, led to the patient

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Area of Science:

  • Toxicology
  • Pharmacology
  • Cardiology

Background:

  • This report details a fatal case of intentional overdose involving diltiazem and metoclopramide.
  • The patient was a 25-year-old female with a history of substance abuse.

Observation:

  • Upon admission, the patient presented with bradycardia, severe hypotension, and third-degree heart block, progressing to asystole.
  • Despite resuscitation, the patient remained comatose and died four days later.

Findings:

  • Serum analysis revealed diltiazem levels of 8.49 mg/L one hour post-admission, with elimination following zero-order kinetics (0.68 mg/L/h).
  • Metoclopramide levels were 4.4 mg/L at one hour, exhibiting biphasic elimination with half-lives of 1.3 h and 20 h.

Implications:

  • This case highlights the severe cardiotoxic potential of combined diltiazem and metoclopramide overdose.
  • Accurate toxicological analysis and understanding drug elimination kinetics are crucial in managing such critical overdoses.

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