title: Third-degree AV block from extended-release diltiazem ingestion in a nine-month-old.
abstract: Calcium channel blocker (CCB) overdose is associated with dysrhythmias and atrioventricular (AV) block, however, experience with infant CCB overdose is limited. A 9-month-old girl was found playing with tablets of extended-release diltiazem 120 mg. The patient had two episodes of emesis, which contained pill fragments, and was brought to the Emergency Department (ED) 4.5 h after being found. Vital signs were: rectal temperature 37.1 degrees C, pulse 87 beats/min, respiratory rate 30-40 breaths/min, blood pressure 72/48 mm Hg, and oxygen saturation (SpO(2)) 99% on room air. Otherwise, the patient was well-appearing, with normal skin color and examination. The electrocardiogram revealed third-degree atrioventricular block with a ventricular rate of 90 beats/min, QRS 68 ms, and QTc 411 ms. Atropine 0.1 mg i.v. was given, which increased the heart rate to 100-110 beats/min. Calcium gluconate 500 mg was also given intravenously. Laboratory evaluation revealed bicarbonate 17 mEq/L, anion gap 16, and glucose 129 mg/dL. On hospital day 1, the patient was noted to have a junctional rhythm with a rate of 90-100, and systolic blood pressure of 80-90 mm Hg. No additional medications were given. Early on day 2, the patient converted spontaneously to a normal sinus rhythm and was discharged approximately 42 h after presentation to the ED. In addition to bradycardia and hypotension, this 9-month-old patient manifested third-degree AV block after ingesting extended-release diltiazem.
authors.affiliation: Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, Washington 98431, USA.
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Wills
authors.forename: J Marc
authors.initials: JM
authors.lastname: Liu
authors.forename: Michael
authors.initials: M
authors.lastname: Wahl
mesh_terms: D054537:Atrioventricular Block / Q000139:chemically induced*; D001919:Bradycardia / Q000139:chemically induced; D002121:Calcium Channel Blockers / Q000506:poisoning*; D004110:Diltiazem / Q000506:poisoning*; D062787:Drug Overdose / Q000175:diagnosis; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007223:Infant
chemical_list: D002121:Calcium Channel Blockers; D004110:Diltiazem