Treatment of polypharmacy overdose with multimodality extracorporeal life support.
A 45-year-old woman presented to the emergency department of a tertiary referral hospital after taking an overdose of verapamil, doxepin, quetiapine, diazepam, temazepam, and clonazepam. She rapidly developed shock refractory to pharmacological support and was placed on percutaneous venoarterial extracorporeal membrane oxygenation (ECMO). She had a severe metabolic acidosis from a combination of shock and drug intoxication that improved with continuous venovenous haemodialysis. Forty-eight hours after presentation, while still on ECMO, the patient had complete cardiac standstill for three and a half hours, attributable to slow-release verapamil, that resolved after the commencement of plasmapheresis. The role of plasmapheresis in verapamil overdose requires further study.
Maclaren
G
G
The Intensive Care Unit, The Alfred Hospital, Commercial Rd, Melbourne, Vic. 3004.
Butt
W
W
Cameron
P
P
Preovolos
A
A
McEgan
R
R
Marasco
S
S
D000138:Acidosis / Q000139:chemically induced* / Q000628:therapy; D062787:Drug Overdose; D004636:Emergency Service, Hospital; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D010951:Plasma Exchange; D011041:Poisoning / Q000628:therapy*; D006435:Renal Dialysis
D004364:Pharmaceutical Preparations