title: Extracorporeal albumin dialysis in three cases of acute calcium channel blocker poisoning with life-threatening refractory cardiogenic shock.
abstract: We describe 3 patients admitted to the medical-surgical ICU in a university hospital with life-threatening cardiogenic shock after the ingestion of high doses of calcium channel blockers (8.4 g sustained-release diltiazem, 4.2 g sustained-release diltiazem, and 14.4 g slow-release verapamil). Cardiovascular failure and cardiac conduction disturbances were unresponsive to the usual therapy (eg, intravenous injection of high doses of calcium, glucagon, hyperinsulinemia-euglycemia therapy, fluid resuscitation) and to increasing doses of simultaneous infusions of adrenergic agonists. Albumin dialysis with Molecular Adsorbents Recirculating System (MARS) therapy was performed because of its unique ability to selectively remove from circulation protein-bound toxins (and potentially drugs) that are not cleared by conventional hemodialysis. A single procedure was successfully performed in each patient, which was followed by rapid weaning of adrenergic agonist agents and full recovery of the life-threatening cardiovascular failure. At 2-year follow-up, patients were asymptomatic. Albumin dialysis with MARS therapy may be effective when used as a rescue procedure in patients presenting with sustained, life-threatening cardiogenic shock as a result of massive calcium channel blocker poisoning.
authors.affiliation: Medical-Surgical Intensive Care Unit, Dupuytren Teaching Hospital, Limoges Cedex, France. nicolas.pichon@chu-limoges.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pichon
authors.forename: Anthony
authors.initials: A
authors.lastname: Dugard
authors.forename: Marc
authors.initials: M
authors.lastname: Clavel
authors.forename: Jean Bernard
authors.initials: JB
authors.lastname: Amiel
authors.forename: Bruno
authors.initials: B
authors.lastname: François
authors.forename: Philippe
authors.initials: P
authors.lastname: Vignon
mesh_terms: D000293:Adolescent; D000418:Albumins / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000097:blood / Q000506:poisoning*; D003692:Delayed-Action Preparations; D004110:Diltiazem / Q000097:blood / Q000506:poisoning*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods; D012770:Shock, Cardiogenic / Q000139:chemically induced* / Q000628:therapy; D014700:Verapamil / Q000097:blood / Q000506:poisoning*
chemical_list: D000418:Albumins; D002121:Calcium Channel Blockers; D003692:Delayed-Action Preparations; D014700:Verapamil; D004110:Diltiazem