title: Drug overdose with refractory bradycardia and hypotension.
abstract: BACKGROUND
  In the emergency department physicians are often called upon to make decisions with limited information. Often the correct diagnosis and treatment hinge on one piece of information, which may be the key to the entire presentation.
  
  
  OBJECTIVE
  We present a case report of a patient who presented with refractory bradycardia and hypotension who had over-dosed on calcium channel blockers as well as beta blockers. The underlying cause however was myxedema. Were it not for the presence of hypothermia, the correct diagnosis of myxedema secondary to severe hypothyroidism could have been missed. We also briefly review the pathophysiology and treatment of myxedema.
  
  
  CONCLUSIONS
  We present a case of refractory bradycardia and hypotension in a patient who had overdosed on calcium channel blockers as well as beta blockers. Paying close attention to all the details of the case eventually uncovered the underlying severe hypothyroidism and myxedema. In the emergency department we are always called upon to make decisions with limited information. It is also paying close attention to all of the information presented that allows one to not miss any key pieces central to the final diagnosis.
authors: Department of Internal Medicine at Christiana Care Health System, Newark, Del, USA.
authors: Shyamkrishnan
authors: S
authors: Ramdas
authors: Lee Ann
authors: LA
authors: Riesenberg
authors: Neil
authors: N
authors: Jasani
mesh_terms: D000959:Antihypertensive Agents / Q000009:adverse effects*; D001919:Bradycardia / Q000139:chemically induced* / Q000628:therapy; D002998:Clonazepam / Q000009:adverse effects*; D004110:Diltiazem / Q000009:adverse effects*; D062787:Drug Overdose; D005260:Female; D018757:GABA Modulators / Q000009:adverse effects*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000628:therapy; D008790:Metoprolol / Q000009:adverse effects*; D008875:Middle Aged
chemical_list: D000959:Antihypertensive Agents; D018757:GABA Modulators; D002998:Clonazepam; D004110:Diltiazem; D008790:Metoprolol