title: Predictors of mortality in verapamil overdose: usefulness of serum verapamil concentrations.
abstract: Verapamil poisoning may result in life-threatening cardiovascular morbidities and fatalities. To date, prognosticators of mortality have been poorly investigated and the use of serum verapamil concentration for prognosis remains unclear. We aimed to evaluate the ability of usual clinical and laboratory parameters including serum verapamil concentrations measured on admission to predict outcome (survival versus death) in verapamil poisoning. We reviewed the medical records of all intentional and symptomatic verapamil poisonings admitted over 8 years to two medical intensive care units. Clinical and laboratory parameters were measured in 65 patients, and final outcomes of survival or death recorded. A multivariable analysis was conducted to evaluate the prognostic values of recorded parameters. Life-threatening complications of verapamil poisonings included shock (62%), atrioventricular blocks (24%), sinoatrial blocks (20%), acute respiratory distress syndrome (19%) and cardiac arrest (11%) resulting in death (8%). Verapamil concentration measured on intensive care unit admission was the only independent factor associated with mortality (p = 0.01). The optimal verapamil cut-off point was 5.0 μM (100% sensitivity, 91% specificity), which conferred a 2.76-times increase in odds of fatality. In conclusion, cardiovascular monitoring and assessment of organ failure are vital in symptomatic verapamil poisonings. The serum verapamil concentration has excellent prognostic ability for predicting fatality in verapamil overdose.
authors.affiliation: Medical and Toxicological Critical Care Department, Lariboisière Hospital, Paris-Diderot University, France. brunomegarbane@wanadoo.fr
authors.forename: Bruno
authors.initials: B
authors.lastname: Mégarbane
authors.forename: Souheil
authors.initials: S
authors.lastname: Karyo
authors.forename: Khalid
authors.initials: K
authors.lastname: Abidi
authors.forename: Brigitte
authors.initials: B
authors.lastname: Delhotal-Landes
authors.forename: Mounir
authors.initials: M
authors.lastname: Aout
authors.forename: Philippe
authors.initials: P
authors.lastname: Sauder
authors.forename: Frédéric J
authors.initials: FJ
authors.lastname: Baud
mesh_terms: D000328:Adult; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D003422:Critical Care; D003692:Delayed-Action Preparations; D062787:Drug Overdose / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced* / Q000150:complications / Q000378:metabolism; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome; D014700:Verapamil / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use
chemical_list: D002121:Calcium Channel Blockers; D003692:Delayed-Action Preparations; D014700:Verapamil