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Lipid rescue of massive verapamil overdose: a case report
Conrad W Liang1, Sarah J Diamond, Daniel S Hagg
1Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97201 USA. haggda@ohsu.edu.
Journal of Medical Case Reports
|August 23, 2011
Summary
Massive verapamil overdose can cause severe toxicity with no known antidote. However, intravenous fat emulsion therapy successfully reversed the effects of a massive verapamil ingestion in a critical care case study.
Area of Science:
- Toxicology
- Cardiology
- Critical Care Medicine
Background:
- Massive intentional verapamil overdose presents a significant toxicological challenge.
- Verapamil toxicity can lead to multiorgan system failure.
- Currently, no specific antidote exists for severe verapamil poisoning.
Purpose of the Study:
- To report a case of massive verapamil overdose.
- To investigate the efficacy of intravenous fat emulsion therapy in treating severe verapamil toxicity.
Main Methods:
- A 41-year-old woman ingested 19.2 g of sustained-release verapamil.
- The patient developed severe hypotension, bradycardia, respiratory failure, and anuric renal failure.
- Standard treatments including vasopressors, calcium, bicarbonate, hyperinsulinemic euglycemic therapy, and hemodialysis were ineffective.
- Continuous intravenous lipid emulsion therapy was initiated on hospital day four.
Main Results:
- Within three hours of initiating lipid therapy, vasopressor requirements were halved.
- Within 24 hours, the patient required minimal vasopressor support and regained a junctional rhythm.
- After three days of lipid infusion, the patient was weaned off inotropic agents and pacing.
Conclusions:
- Intravenous fat emulsion therapy demonstrated a significant therapeutic effect in this case of massive verapamil overdose.
- Lipid emulsion therapy may represent a potential antidote for severe verapamil toxicity.
- This case highlights the utility of lipid emulsion in managing life-threatening calcium channel blocker poisoning.
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