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A case of severe verapamil overdose
1Department of Cardiology, Kita Osaka Hospital, Osaka, Japan.
Japanese Circulation Journal
|April 29, 1998
Summary
A severe verapamil overdose case highlights the importance of prompt treatment. This study details a successful resuscitation protocol for a patient experiencing extreme hypotension and cardiac issues after ingesting a large verapamil dose.
Area of Science:
- Cardiology
- Clinical Toxicology
- Pharmacology
Background:
- Verapamil, a calcium channel blocker, is used to treat hypertension and arrhythmias.
- Overdose can lead to severe cardiovascular complications, including hypotension and conduction abnormalities.
Observation:
- A 73-year-old female ingested 3.6g of verapamil, presenting with delayed loss of consciousness, severe hypotension, and atrioventricular dissociation.
- Despite profound hypotension, echocardiography showed preserved cardiac wall motion and cardiac output.
- Plasma verapamil concentration reached 1499 ng/ml 4 hours post-ingestion, with persistent hyperglycemia and hypokalemia.
Findings:
- Successful resuscitation was achieved using intravenous saline, dopamine, and norepinephrine.
- The case demonstrates a high verapamil level associated with significant hemodynamic compromise but preserved cardiac contractility.
- Hyperglycemia and hypokalemia were notable laboratory findings requiring management.
Implications:
- This case underscores the potential for severe toxicity even with seemingly preserved cardiac function on echocardiogram.
- It highlights the efficacy of supportive care and vasopressor therapy in managing verapamil overdose.
- The findings contribute to understanding the clinical course and treatment strategies for severe verapamil poisoning.