Critical Care Management ofVerapamil and Diltiazem Overdose With a Focus on Vasopressors: A 25-Year Experience at a Single Center

Levine, Michael; Curry, Steven C.; Padilla-Jones, Angela; Ruha, Anne‐Michelle

doi:10.1016/j.annemergmed.2013.03.018

Cited by 68 publications

(52 citation statements)

References 18 publications

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“…On the other hand, while several case reports indicate amelioration of CCB-induced cardiotoxicity by the administration of ILE [8][9][10][11], others report no benefit [12]. Hence, there are many open questions remaining such as the mechanism of ILE action, the optimal time and dose of ILE administration [9,11,13], and the interaction of ILE with other therapy being administrated. A working group charged with developing evidence-based recommendations on the use of ILE therapy in poisoning has recently been formed [14].…”

Section: Introductionmentioning

confidence: 99%

In Vitro Studies Indicate Intravenous Lipid Emulsion Acts as Lipid Sink in Verapamil Poisoning

et al. 2015

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Intravenous lipid emulsion (ILE), a component of parenteral nutrition, consists of a fat emulsion of soy bean oil, egg phospholipids, and glycerin. Case reports suggest that ILE may reverse hypotension caused by acute poisoning with lipophilic drugs such as verapamil, but the mechanism remains unclear. The methods used are the following: (1) measurement of ILE concentration in serum samples from a patient with verapamil poisoning treated with ILE, (2) measurement of free verapamil concentrations in human serum mixed in vitro with increasing concentrations of ILE, and (3) measurement of murine ventricular cardiomyocyte L-type Ca 2+ currents, intracellular Ca 2+ , and contractility in response to verapamil and/or ILE. Maximum patient serum ILE concentration after infusion of 1 L ILE over 1 h was approximately 1.6 vol%. In vitro GC/ MS verapamil assays showed that addition of ILE (0.03-5.0 vol%) dose-dependently decreased the free verapamil concentration in human serum. In voltage-clamped myocytes, adding ILE to Tyrode's solution containing 5 μM verapamil recovered L-type Ca 2+ currents (I Ca ). Recovery was concentration dependent, with significant I Ca recovery at ILE concentrations as low as 0.03 vol%. ILE had no effect on I Ca in the absence of verapamil. In field-stimulated intact ventricular myocytes exposed to verapamil, adding ILE (0.5 %) resulted in a rapid and nearly complete recovery of myocyte contractility and intracellular Ca 2+ . Our in vitro studies indicate that ILE acts as a lipid sink that rapidly reverses impaired cardiomyocyte contractility in the continued presence of verapamil.

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Section: Introductionmentioning

confidence: 99%

In Vitro Studies Indicate Intravenous Lipid Emulsion Acts as Lipid Sink in Verapamil Poisoning

et al. 2015

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“…Because the treatment protocol for calcium channel blocker intoxication is supported by low-quality evidence, the treatment regimen is determined according to the severity of symptoms, including high-dose insulin, intravenous calcium gluconate injection, intravenous glucagon injection, intravenous vasopressor infusion and lipid emulsion therapy (5). Furthermore, it has been reported that extracorporeal life support is associated with a survival benefit in the setting of multiorgan dysfunction, severe shock and/or cardiac arrest after diltiazem overdose (5,(10)(11)(12). Although our patient was managed conservatively, his clinical course was uneventful and the serum diltiazem concentration decreased on day 3 (35.9 ng/mL).…”

Section: Discussionmentioning

confidence: 72%

Ischemic Acute Tubular Necrosis due to Diltiazem Overdose

et al. 2016

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Diltiazem overdose has a high mortality rate due to cardiotoxicity associated with bradycardia and hypotension. A previous article reported that this type of overdose can cause acute tubular necrosis, which was not pathologically, but rather clinically, diagnosed. We herein report the case of a 55-year-old man who sustained nonoliguric acute kidney injury after taking 60 diltiazem tablets. A kidney biopsy performed six days after admission showed ischemic, not toxic, acute tubular necrosis. The patient's kidney function improved spontaneously. In this case report, we clarify the cause of renal impairment caused by diltiazem overdose pathologically. Physicians should therefore consider ischemic acute tubular necrosis as a cause of kidney injury in patients with diltiazem overdose.

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“…Isoproterenol is a non‐selective β‐adrenoreceptor to treat bradycardia associated with diltiazem and verapamil overdoses, which cause cardiotoxicity 12. Based on the current report,13 isoproterenol was used at 5–25 μg/min (maximal infusion rate is 60 μg/min). In our case, we started isoproterenol at 12 μg/min and increased up to 30 μg/min.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of isoproterenol for treating amlodipine overdose resulting in bradycardia

Ebihara

Morita

Kawada

et al. 2017

Acute Medicine & Surgery

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CaseAmlodipine predominantly affects vascular smooth muscle cells. Amlodipine overdose usually presents with vasodilatory shock, accompanied by reflex tachycardia rather than bradycardia.An 81‐year‐old woman presented with impaired consciousness 8 h after ingesting 50 5‐mg amlodipine tablets with suicidal intent. On admission, her blood pressure was 50/40 mmHg and her heart rate was 45 b.p.m. Serum amlodipine level was extremely high (474.4 ng/mL), causing refractory bradycardia. She remained hypotensive despite fluid resuscitation, and therefore was administered dopamine and norepinephrine. She was also administered glucagon and calcium gluconate, and underwent high‐dose insulin euglycemic therapy.OutcomeAlthough her blood pressure improved, bradycardia progressively worsened and isoproterenol infusion was initiated, which resulted in an improvement in her heart rate. The patient discharged on day 14 without any complications.ConclusionIsoproterenol is effective for treating bradycardia after amlodipine overdose.

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Critical Care Management ofVerapamil and Diltiazem Overdose With a Focus on Vasopressors: A 25-Year Experience at a Single Center

Cited by 68 publications

References 18 publications

In Vitro Studies Indicate Intravenous Lipid Emulsion Acts as Lipid Sink in Verapamil Poisoning

In Vitro Studies Indicate Intravenous Lipid Emulsion Acts as Lipid Sink in Verapamil Poisoning

Ischemic Acute Tubular Necrosis due to Diltiazem Overdose

Efficacy of isoproterenol for treating amlodipine overdose resulting in bradycardia

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