title: Surprisingly delayed escalation of severe verapamil poisoning.
abstract: We present a case report of intoxication by a potentially lethal dose of sustained-release verapamil with delayed escalation of complications. The patient was hospitalized 1.5 h after an attempted suicide with a very high dose of verapamil sustained-release (7.2 g). On admission the plasma concentrations were extremely high (3600 ng/l). Heart rate and blood pressure declined slowly with a surprising sudden escalation on the third day coupled with hemodynamic collapse and loss of consciousness. Complete recovery was achieved in spite of 2 h of extreme hypotension. We outline the clinical course, a need for massive bowel irrigation in case of sustained-release medication, the timing of a temporary pacing and the effect of centralization of circulation even on invasively measured blood pressure.
authors.affiliation: 3rd Department of Internal Medicine, General University Hospital and 1st Medical School, Prague, Czech Republic. Vladimir.Tuka@vfn.cz
authors.forename: Vladimir
authors.initials: V
authors.lastname: Tuka
authors.forename: Bronislava
authors.initials: B
authors.lastname: Ricarova
authors.forename: Tomas
authors.initials: T
authors.lastname: Janota
authors.forename: Jan
authors.initials: J
authors.lastname: Malik
authors.forename: Eva
authors.initials: E
authors.lastname: Kotrlikova
mesh_terms: D000368:Aged; D001795:Blood Pressure Determination; D002121:Calcium Channel Blockers / Q000506:poisoning*; D003128:Coma / Q000139:chemically induced*; D003692:Delayed-Action Preparations / Q000506:poisoning; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000175:diagnosis; D008297:Male; D013406:Suicide, Attempted; D014700:Verapamil / Q000506:poisoning*
chemical_list: D002121:Calcium Channel Blockers; D003692:Delayed-Action Preparations; D014700:Verapamil