title: Fatal unintentional overdose of diltiazem with antemortem and postmortem values.
abstract: BACKGROUND
  Therapeutic errors involving calcium channel antagonists (CCA) resulting in death rarely have been reported in detail. We report a fatality from an unintentional overdose of sustained-release (SR) diltiazem including antemortem and postmortem blood concentrations.
  
  
  METHODS
  A 65-year-old man with aortic stenosis mistakenly took six tablets of diltiazem 360 mg SR. He developed symptoms of toxicity by 7 hours after ingestion. By 10 hours, he went to the emergency department. Despite a prolonged resuscitative attempt, the patient died 17 hours postingestion. An antemortem blood sample drawn 11.5 hours after ingestion was 2.9 mcg/mL. Postmortem gas chromatography of central blood revealed a diltiazem level of 6 mcg/mL and the peripheral blood sample measured 5 mcg/ mL.
  
  
  CONCLUSIONS
  This case suggests that an unintentional overdose with a CCA may be lethal if the patient's cardiovascular ability to compensate for the toxic effects is compromised.
authors.affiliation: California Poison Control System, San Diego Division, San Diego, California 92103-8925, USA. fcantrel@ucsd.edu
authors.forename: F Lee
authors.initials: FL
authors.lastname: Cantrell
authors.forename: Saralyn R
authors.initials: SR
authors.lastname: Williams
mesh_terms: D000368:Aged; D004110:Diltiazem / Q000097:blood / Q000506:poisoning*; D062787:Drug Overdose; D017809:Fatal Outcome; D006801:Humans; D008297:Male
chemical_list: D004110:Diltiazem