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[Verapamil intoxication: beware of the delayed effect].

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Calcium channel blocker overdose, especially extended-release verapamil, can cause severe vasoplegic shock and heart conduction issues. Prompt pediatric intensive care with epinephrine and insulin is crucial for recovery in these rare but dangerous poisonings.

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Area of Science:

  • Toxicology
  • Pediatric Emergency Medicine
  • Cardiology

Background:

  • Calcium channel blockers (CCBs) are widely prescribed cardiovascular drugs.
  • Intoxication with CCBs, though rare, carries a significant mortality rate of approximately 10%.

Observation:

  • A 5-year-old girl ingested a large dose of extended-release verapamil (VLP) and bromazepam.
  • She presented 30 hours post-ingestion with delayed-onset vasoplegic shock, cardiac conduction abnormalities, and metabolic disturbances.

Findings:

  • The extended-release formulation of verapamil contributed to delayed and prolonged drug absorption, exacerbating toxicity.
  • Continuous infusions of epinephrine and insulin were critical in managing the vasoplegia and metabolic complications.
  • Complete recovery was achieved 60 hours after the initial ingestion.

Implications:

  • This case highlights the critical danger of extended-release calcium channel blocker overdoses, emphasizing the need for vigilance in pediatric poisoning cases.
  • Understanding the pharmacokinetics of extended-release CCBs, including slowed gastric motility and prolonged absorption, is vital for effective treatment strategies.
  • Awareness of these mechanisms can help reduce mortality associated with calcium channel blocker intoxication.