title: [Severe pulmonary complications of massive intoxication with calcium channel blockers and isosorbide mononitrate--a case report].
abstract: A 22-year-old man was admitted to the acute intoxication unit after suicidal intoxication with 100 tablets of verapamil, diltiazem and isosorbide mononitrate. He developed shock, paralytic ileus and adult respiratory distress syndrome (ARDS). The patient required high doses of catecholamines and mechanical ventilation with high inspiratory pressure. Pulmonary barotrauma (pneumothorax, pneumomediastinum, pneumoperitoneum and soft tissue emphysema) was a secondary complication to mechanical ventilation. It is well known that alveolar epithelial type II cells synthesize and secrete all components of the surfactant. Surfactant secretion in epithelial type II cells is inhibited by calcium channel blockers and it predisposes to develop ARDS. This case illustrates the possibility of ARDS in the verapamil and diltiazem intoxication and the need for a heightened awareness of this potential complication.
authors.affiliation: Oddział Ostrych Zatruć, Dolnoślaskiego Szpitala Specjalistycznego im. T. Marciniaka, Centrum Medycyny Ratunkowej we Wrocławiu.
authors.forename: Jan
authors.initials: J
authors.lastname: Magdalan
authors.forename: Andrzej
authors.initials: A
authors.lastname: Antończyk
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kowalski
authors.forename: Michał
authors.initials: M
authors.lastname: Przewłocki
authors.forename: Krystyna
authors.initials: K
authors.lastname: Kochman
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Wasylko-Smolarek
mesh_terms: D000328:Adult; D002121:Calcium Channel Blockers / Q000506:poisoning*; D004110:Diltiazem / Q000506:poisoning*; D006801:Humans; D007548:Isosorbide Dinitrate / Q000031:analogs & derivatives* / Q000506:poisoning*; D008297:Male; D012128:Respiratory Distress Syndrome / Q000139:chemically induced* / Q000628:therapy; D013406:Suicide, Attempted; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000506:poisoning*; D014700:Verapamil / Q000506:poisoning*
chemical_list: D002121:Calcium Channel Blockers; D014665:Vasodilator Agents; D014700:Verapamil; D004110:Diltiazem; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate