[Verapamil intoxication: beware of the delayed effect].
C Charpentier1, M Flandrois1, F Labombarda2
1Service de réanimation pédiatrique, pôle Femme-Enfant, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
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.
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.
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