title: [Verapamil intoxication: beware of the delayed effect].
abstract: Intoxication with calcium channel inhibitory drugs is rare but mortality rates reach 10 %. We report the case of a 5-year-old girl who had ingested five 240-mg tablets of extended-release verapamil (VLP) and a tablet of bromazepam. Thirty hours after the ingestion she had a vasoplegic shock, heart conduction disorders, and metabolic complications. She was treated in pediatric intensive care with continuous epinephrine and insulin and recovered completely 60h after the ingestion. This case underlines the danger of calcium channel blocker overdose, increased by the extended-release mechanism: the drug effect is to slow down gastric motility - which explains the latency of the symptoms - but this also increases the drug absorption, inducing a vicious circle. These mechanisms in calcium blocker intoxication need to be kept in mind in order to decrease the mortality of such accidents.
authors.affiliation: Service de réanimation pédiatrique, pôle Femme-Enfant, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
authors.forename: C
authors.initials: C
authors.lastname: Charpentier
authors.affiliation: Service de réanimation pédiatrique, pôle Femme-Enfant, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Flandrois
authors.affiliation: Service de cardiologie, CHU Caen - Côte-de-Nacre, 14033 Caen, France.
authors.forename: F
authors.initials: F
authors.lastname: Labombarda
authors.affiliation: Service de cardiologie, CHU Caen - Côte-de-Nacre, 14033 Caen, France.
authors.forename: P
authors.initials: P
authors.lastname: Maragnes
authors.affiliation: Service de réanimation pédiatrique, pôle Femme-Enfant, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Jokic
authors.affiliation: Service de réanimation pédiatrique, pôle Femme-Enfant, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France. Electronic address: villedieu-f@chu-caen.fr.
authors.forename: F
authors.initials: F
authors.lastname: Villedieu
mesh_terms: D002121:Calcium Channel Blockers / Q000506:poisoning*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D011041:Poisoning / Q000175:diagnosis / Q000628:therapy; D013997:Time Factors; D014700:Verapamil / Q000506:poisoning*
chemical_list: D002121:Calcium Channel Blockers; D014700:Verapamil