title: Serum verapamil concentrations before and after Intralipid® therapy during treatment of an overdose.
abstract: CONTEXT. Intralipid® infusion is useful in reversing cardiac and central nervous system toxicity of local anesthetic drugs, and recent reports suggest utility in other drug overdoses. CASE DETAILS. A 47-year-old man presented to the emergency department with hypotension and complete heart block 3 h after a sustained-release verapamil overdose. He was given supportive care including calcium and hyperinsulinemia/euglycemia therapy. Nineteen and 29 h post-ingestion, Intralipid® was administered as a bolus, followed by an infusion. OBJECTIVE. The objective of this study was to determine the serum verapamil concentrations before and after Intralipid® administration and to ascertain its clinical effects. DISCUSSION. It was found that administration of Intralipid® was followed by a decrease in verapamil concentration once the lipid had been removed from the sample, demonstrating that Intralipid® was effective in sequestering verapamil, effectively removing it from the serum, and supporting its use in the treatment of verapamil overdose. Intralipid® administration was associated with an increase in the patient's blood pressure, but because other vasoactive drugs were given at the same time, it was difficult to determine its relative contribution to clinical improvement.
authors.affiliation: Department of Laboratory Medicine, University of California San Francisco, USA. deborah.french@sucsf.edu
authors.forename: Deborah
authors.initials: D
authors.lastname: French
authors.forename: Patil
authors.initials: P
authors.lastname: Armenian
authors.forename: Weiming
authors.initials: W
authors.lastname: Ruan
authors.forename: Alicia
authors.initials: A
authors.lastname: Wong
authors.forename: Kenneth
authors.initials: K
authors.lastname: Drasner
authors.forename: Kent R
authors.initials: KR
authors.lastname: Olson
authors.forename: Alan H B
authors.initials: AH
authors.lastname: Wu
mesh_terms: D002121:Calcium Channel Blockers / Q000506:poisoning*; D062787:Drug Overdose / Q000188:drug therapy; D004655:Emulsions / Q000627:therapeutic use; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010743:Phospholipids / Q000627:therapeutic use*; D013024:Soybean Oil / Q000627:therapeutic use*; D014280:Triglycerides / Q000097:blood; D014700:Verapamil / Q000097:blood / Q000506:poisoning*
chemical_list: D002121:Calcium Channel Blockers; D004655:Emulsions; D005217:Fat Emulsions, Intravenous; D010743:Phospholipids; D014280:Triglycerides; C545823:soybean oil, phospholipid emulsion; D013024:Soybean Oil; D014700:Verapamil