A Case Report of Hypotension and Bradycardia Associated with Immediate-Release Diltiazem Overdose
نویسندگان
چکیده
A 31-year-old female had attempted suicide with 56 diltiazem 30 mg immediate-release (IR) tablets of her father’s prescription and was admitted into emergency department after one hour of ingestion. First vital signs revealed temperature of 36.2 , blood pressure of 58/27 mmHg and pulse of 7 °C 1 beats/min. The electrocardiogram showed junctional bradycardia. She was given the following treatment: GI decontamination (activated charcoal, AC 61.5g), antidotes (calcium gluconate 10% 10mL and glucagon 3mg) and supportive care (atropine 1mg, dopamine 800mg, norepinephrine 8mg and normal saline 500mL). After 12 hours of emergency treatment, her blood pressure and heart rate returned to normal (114/70 mmHg and 88 beats/min). Finally, she was subsequently transferred to the intensive care unit for further observation and treatment, and then discharged after 4 days of admission. In calcium channel blockers (CCBs) intoxication, hypotension and bradycardia are the most important clinical features and nondihydropyridine classes have much effect in suppression cardiac contractility. In this case, copious medication was used to treat 1) hypotension and 2) bradycardia respectively: 1) calcium gluconate, dopamine, norepinephrine and insulin; 2) calcium gluconate, glucagon and atropine. This case successfully treated suicidal diltiazem overdose, and showed that in the management of CCB overdose, attention must be paid to severe fetal side effects of hypotension and bradycardia using various medications with the purpose of maintaining the vital signs.
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