title: Pharmacokinetics and toxic effects of diltiazem in massive overdose.
abstract: A 50-year-old man with ischaemic heart disease took 98 tablets of diltiazem 60 mg with alcohol. He developed a junctional bradycardia, hypotension and reduced cardiac function refractory to intravenous calcium gluconate. He survived with temporary cardiac pacing and infusion of dopamine. As much as half the dose was vomited back, but nonetheless the plasma diltiazem concentration reached 6090 micrograms/l before falling mono-exponentially with a half-life of 8.6 h. Sinus rhythm returned when the plasma concentration of diltiazem was around 750 micrograms/l. Standard resuscitative procedures sufficed to treat massive diltiazem overdosage.
authors.affiliation: Regional Clinical Pharmacology Unit, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: R E
authors.initials: RE
authors.lastname: Ferner
authors.forename: O
authors.initials: O
authors.lastname: Odemuyiwa
authors.forename: A B
authors.initials: AB
authors.lastname: Field
authors.forename: S
authors.initials: S
authors.lastname: Walker
authors.forename: G N
authors.initials: GN
authors.lastname: Volans
authors.forename: D N
authors.initials: DN
authors.lastname: Bateman
mesh_terms: D000328:Adult; D004110:Diltiazem / Q000493:pharmacokinetics* / Q000506:poisoning; D006207:Half-Life; D006801:Humans; D008297:Male; D013405:Suicide
chemical_list: D004110:Diltiazem