title: Delayed diagnosis of diltiazem overdose in a patient presenting with thrombosis of femoral artery.
abstract: Previous cases of diltiazem overdose described patients who presented with hypotension, heart block, bradycardia, or ultimately death. This report concerns an elderly patient presenting to the emergency room with hypotension, an ischemic leg and confusion. He underwent an emergency thrombectomy of the femoral artery. He had severe lactic acidosis, persistent hypotension requiring prolonged inotropic support and difficulty being weaned from the ventilator after the operation. Subsequent investigations confirmed that he attempted suicide by taking an unknown quantity of diltiazem. Because diltiazem has been increasingly prescribed to treat various cardiovascular disorders, overdose may become a more common problem. A high index of suspicion is required to ensure prompt diagnosis and appropriate treatment when patients taking this medication present with sudden circulatory collapse. A guide to the management of diltiazem overdose is provided.
authors.affiliation: Division of General Internal Medicine, Toronto Hospital, Ontario.
authors.forename: A W
authors.initials: AW
authors.lastname: Chan
authors.forename: K W
authors.initials: KW
authors.lastname: Johnston
authors.forename: Z
authors.initials: Z
authors.lastname: Verjee
authors.forename: W A
authors.initials: WA
authors.lastname: Demajo
mesh_terms: D001919:Bradycardia / Q000175:diagnosis; D004110:Diltiazem / Q000008:administration & dosage* / Q000009:adverse effects; D062787:Drug Overdose / Q000175:diagnosis*; D004562:Electrocardiography; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D013406:Suicide, Attempted; D017131:Thrombectomy; D013924:Thrombophlebitis / Q000601:surgery*; D013997:Time Factors
chemical_list: D004110:Diltiazem