Survival despite extremely high plasma diltiazem level in a case of acute poisoning treated by the molecular-adsorbent recirculating system

Abstract

nurses spend more time at bedside than do ED physicians, and may deliver contradictory information. Therefore, impact of nurses' involvement should be assessed to improve procedure efficacy. We acknowledge that our population was highly selected, and sample size was small and not calculated a priori. Consequently, translating results in other settings seems disputable. We observed that junior physicians informed nearly half the patients. Although this corresponds to real life, one could argue that the gold standard should be the information by senior physicians. However, junior physicians can provide valuable information [5]. Of note, patients from the control group more frequently received information from senior physicians. In addition, we could not assess whether the study questionnaire could have guided physicians' behavior and improved information quality. Finally, applying our procedure can be perceived as time-consuming. Therefore, providing diagnosis and severity may be sufficient if physicians give patients the opportunity to ask questions, and answer them.Herein we demonstrate that a standardized procedure to deliver basic information improves the understanding in complex ED patients. This makes sense as practice in ED exposes to detrimental communication gaps in severe patients [1,3]. Further investigations are needed to ascertain these promising results.

Treatment for calcium channel blocker poisoning: A systematic review

“… 124 , 125 One human case series 126 and two case reports 127 , 128 suggested use of plasma exchange to decrease verapamil concentrations and improve hemodynamics. One human case series of three patients 129 and one case report 130 suggested the use of extracorporeal albumin dialysis to improve hemodynamics without a clear impact on the serum CCB concentrations. Only human case reports were found for charcoal hemoperfusion; 131 continuous venovenous hemodiafiltration; 132–135 insertion of an intra-aortic balloon pump, 136 Impella device, 137 and methylene blue.…”

“…93–94 Extracorporeal life support 22 for patients with cardiac arrest or severe shock refractory to conventional therapy reported a benefit in survival. Two patients survived with albumin dialysis, 129 , 130 and only animal studies supported the use of Bay K8644. 100 , 101 , 103…”

Circulatory Support with Venoarterial ECMO Unsuccessful in Aiding Endogenous Diltiazem Clearance after Overdose

“…She developed profoundly elevated diltiazem serum concentrations and an inconsistent drug decay curve after this overdose. The peak concentration noted was approximately 100-fold greater than the therapeutic range (100–200 ng/mL) and is at the upper limit of what has previously been reported [4–6, 8–11]. No consistent diltiazem elimination rate occurred and levels remained significantly elevated to hour 90 of admission.…”

Treatment of Severe Amlodipine Toxicity With Molecular Adsorbent Recirculating System

“…There are case reports of using extracorporeal liver support to treat calcium channel blocker overdose 5, 6, 7, 8. Three individuals in cardiogenic shock from diltiazem and verapamil poisoning were treated with albumin dialysis.…”