[Gallopamil poisoning. Its course and therapy].

Area of Science:

• Cardiology
• Clinical Toxicology

Background:

• Gallopamil is a calcium antagonist used to treat cardiovascular conditions.
• Calcium antagonists can cause severe toxicity, including hypotension and arrhythmias, in overdose situations.

Observation:

• A 32-year-old woman presented with somnolence, severe hypotension (40 mm Hg systolic), and third-degree atrioventricular block after ingesting 7 g of Gallopamil.
• Standard treatments including orciprenaline, dopamine, dobutamine, and calcium were ineffective.

Findings:

• Massive doses of adrenaline and noradrenaline, administered over 26 hours, normalized blood pressure.
• Transitory pacing and subsequent catecholamine administration resolved the arrhythmia within 24 hours.
• Plasma Gallopamil concentration was 8.4 micrograms/ml, approximately 100 times the therapeutic range.

Implications:

• Catecholamines can be effective in managing severe hypotension and arrhythmias caused by Gallopamil overdose.
• This case underscores the critical role of aggressive hemodynamic support in severe calcium antagonist poisoning.
• High plasma concentrations of Gallopamil indicate significant toxicity requiring intensive medical intervention.