Surprisingly delayed escalation of severe verapamil poisoning.
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.
Tuka
Vladimir
V
3rd Department of Internal Medicine, General University Hospital and 1st Medical School, Prague, Czech Republic. Vladimir.Tuka@vfn.cz
Ricarova
Bronislava
B
Janota
Tomas
T
Malik
Jan
J
Kotrlikova
Eva
E
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*
D002121:Calcium Channel Blockers; D003692:Delayed-Action Preparations; D014700:Verapamil