Successful resuscitation of a patient with continuous venovenous hemodiafiltration following intoxication from verapamil and trandolapril.

The incidence of accidental or intentional intoxication resulting from calcium channel blockers (CCBs) overdose has increased in recent years. We herein present the case of a female patient whose condition deteriorated even after she had received the maximum possible medical treatments following intoxication, but was successfully resuscitated following continuous hemodiafiltration (CHDF). A 26-year-old female patient had received 4.8 g of verapamil and 80 mg of trandolapril (Tarka Forte). No abnormality was noted in the systemic examination, and gastric lavage was performed. Four hours after admission, the patient began to develop hypotension. Dopamine infusion was started. The patient was given intravenous infusion of calcium, 2 mg glucagon, 20% intralipid solution infusion, and 20 U/hour insulin, along with 30% dextrose solution. However, even though vasopressor agents were continued at the maximum dose, hypotension persisted, and she subsequently developed bradycardia with thirddegree atrioventricular block. The patient was intubated and a transvenous pacemaker was inserted. Her blood analysis revealed the following measurements: pH, 7.14; PCO2, 35 mmHg; HCO3, 7.1 mmol/L; and lactate, 8 mmol/L. Continuous venovenous hemodiafiltration (CVVHDF) was initiated. The patient’s condition improved, with systolic blood pressure reaching 80e90 mmHg. She was extubated 12 hours later.