Successful treatment of polymedicamentous poisoning with metoprolol, diltiazem and cilazapril

Radovanović, Milan; Miletić, Goran M.

doi:10.2298/vsp0911904r

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…But, this patient was admitted to hospital 10 hours after ingestion of drug and asystole was observed before pacemaker insertion. Another patient with calcium channel antagonist overdose who was successfully treated with pacemaker insertion was reported by Punukollu et al 32 A 28-year-old female patient who was hospitalized for cardiogenic shock and altered state of consciousness (Glasgow coma score ¼ 4), caused by acute poisoning with beta adrenergic blocker and calcium channel antagonist, was reported by Radovanović et al 33 In that patient, prolonged cardiopulmonary resuscitation was applied during the first 16 hours of hospitalization and finally the patient was treated successfully with sympathomimetics, temporary pacemaker, and mechanical ventilation. In our patient, fluid resuscitation, calcium, insulin, and sympathomimetic therapies failed but with pacemaker insertion, as in the cases in the literature, successful treatment was achieved.…”

Section: Discussionmentioning

confidence: 98%

Tarka® overdose in a young child

et al. 2010

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Tarka® is a combination antihypertensive medication composed of verapamil hydrochloride and trandolapril. A 3.5-year-old female was brought to our hospital due to a sleepy condition 7 hours after an accidental ingestion of six tablets of Tarka® containing 240 mg verapamil hydrochloride and 4 mg trandolapril in each tablet. Five hours after hospitalization, her condition deteriorated and arterial pressure progressively decreased despite the treatment. Finally, a temporary pacemaker was implanted, after which the vital findings began to return to normal values. The pacemaker was removed 13 hours after implantation as normal heart rhythm was observed. There are no reports of intoxication with fixed-dose combination products, especially Tarka®, in young children in the literature. Therefore, we believe that our report can provide an insight on the toxic dose of this drug in younger children. Clinicians should keep in mind that lethargy can be the first symptom of a possible clinical deterioration, even in normotensive and normorhythmic individuals.

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Section: Discussionmentioning

confidence: 98%

Tarka® overdose in a young child

et al. 2010

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“…Specific measures suggested for a treatment of CCB poisoning include administration of high dose of insulin, calcium, dopamine, noradrenaline or LET [7][8][9][10] . As demonstrated in our case, most of the recommended therapeutic options were performed with no satisfactory result, prompting another approach -extracorporeal life support.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal life support for severe cardiogenic shock induced by diltiazem intoxication

et al. 2019

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Introduction. Management of cardiogenic shock caused by severe drug intoxication is always challenging. In case of multidrug intoxication, a result, despite aggressive medical therapy, is often unpredictable. Utilization of extracorporeal life support devices in these cases has been suggested and reported results are promising. Case report. We presented a case of profound cardiogenic and distributive shock caused by suicidal intoxication with diltiazem and anionic surfactant ingestion in a 36-year-old woman. The patient ingested more than 90 tablets of diltiazem of 90 mg (ingested dose of 8.1 g), and 4 pieces of household toilet refresh agent containing anionic surfactant. During the admission, systemic blood pressure was 65/40 mmHg, heart rate 45 beats per minute, with signs of metabolic acidosis. The patient underwent several repeated gastric lavages. Emergent fluid resuscitation, calcium gluconate, insulin and vasopressive agents (dopamine and noradrenaline) infusions were administered with negligible effect. Due to progressive and refractory cardiogenic shock with signs of multiorgan failure, a decision was made to put the patient on venoarterial extracorporeal membrane oxygenator. Immediately after starting the extracorporeal membrane oxygenation, diuresis was established. During the next 36 h, an adequate end-organ perfusion was achieved with complete reversal of multiorgan failure. After the successful restoration of all major organ functions, the patient was successfully decannulated and discharged from the hospital after 10 days in a good condition. Conclusion. In severe cases of refractory cardiogenic and distributive shock due to diltiazem and other poison intoxication, venoarterial extracorporeal membrane oxygenation could allow additional circulatory support providing the bonus time for endogenous clearance of toxins. Venoarterial extracorporeal membrane oxygenation could be used in conjunction with the optimal medical therapy aiming to the restoration of end-organ perfusion and allowing for intrinsic drug and toxin metabolism and natural elimination.

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Successful treatment of polymedicamentous poisoning with metoprolol, diltiazem and cilazapril

Abstract: Prompt measures of cardiopulmonary resuscitation and multidisciplinary treatment in intensive care units significantly increase the chances of complete recovery of a patient with severe poisoning caused by drugs with cardiodepressive efects.

Cited by 2 publications

References 11 publications

Tarka® overdose in a young child

Tarka® overdose in a young child

Extracorporeal life support for severe cardiogenic shock induced by diltiazem intoxication

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