title: Lessons learnt in the pharmacokinetic analysis of the effect of haemoperfusion for acute overdose with sustained-release diltiazem.
abstract: The effect of charcoal haemoperfusion on the pharmacokinetics of diltiazem is described in a patient with severe clinical toxicity following acute overdose. The patient presented within 3 h following acute ingestion of multiple medications including sustained-release diltiazem. Routine resuscitation and supportive care were administered, but hypotension did not resolve despite intravenous fluids and infusions of calcium, adrenaline, noradrenaline and vasopressin. Multiple-doses of activated charcoal, haemodialysis and charcoal haemoperfusion were prescribed to expedite the elimination of diltiazem. The maximum diltiazem concentration (577 microg.l(-1)) was recorded 7 h post ingestion which was followed by an erratic and prolonged elimination phase. The maximum clearance of diltiazem due to haemoperfusion was calculated to be 19.4 and 15.1 ml.min(-1) at different times, equating to removal of approximately 1.5 mg diltiazem during 4 h of haemoperfusion. Haemoperfusion did not appear to remove sufficient diltiazem to recommend its routine use in the treatment of patients with acute diltiazem overdose.
authors.affiliation: Burns, Trauma and Critical Care Research Centre, University of Queensland, Butterfield Street, Herston, Australia. 1darren1@gmail.com
authors.forename: D M
authors.initials: DM
authors.lastname: Roberts
authors.forename: J A
authors.initials: JA
authors.lastname: Roberts
authors.forename: R J
authors.initials: RJ
authors.lastname: Boots
authors.forename: R
authors.initials: R
authors.lastname: Mason
authors.forename: J
authors.initials: J
authors.lastname: Lipman
mesh_terms: D000208:Acute Disease; D000328:Adult; D000959:Antihypertensive Agents / Q000097:blood / Q000506:poisoning; D002121:Calcium Channel Blockers / Q000097:blood / Q000506:poisoning; D002606:Charcoal; D003692:Delayed-Action Preparations; D004110:Diltiazem / Q000097:blood* / Q000506:poisoning*; D062787:Drug Overdose / Q000097:blood / Q000628:therapy; D006464:Hemoperfusion; D006801:Humans; D008297:Male; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D003692:Delayed-Action Preparations; D002606:Charcoal; D004110:Diltiazem