TY - JOUR
T1 - Lipid rescue of massive verapamil overdose
T2 - A case report
AU - Liang, Conrad W.
AU - Diamond, Sarah J.
AU - Hagg, Daniel S.
N1 - Funding Information:
This work was supported by the Division of Pulmonary and Critical Care Medicine.
PY - 2011
Y1 - 2011
N2 - Introduction. Massive intentional verapamil overdose is a toxic ingestion which can cause multiorgan system failure and has no currently known antidote. Case Presentation. The patient is a 41-year-old Caucasian woman who ingested 19.2 g of sustained release verapamil in a suicide attempt. Our patient became hypotensive requiring three high-dose vasopressors to maintain arterial pressure. She also developed acute respiratory failure, bradycardic ventricular rhythm necessitating continuous transvenous pacing, and anuric renal failure. Our patient was treated with intravenous calcium, bicarbonate, hyperinsulinemic euglycemic therapy and continuous venovenous hemodialysis without success. On the fourth day after hospital admission continuous intravenous lipid therapy was initiated. Within three hours of beginning lipid therapy, our patient's vasopressor requirement decreased by half. Within 24 hours, she was on minimal vasopressor support and regained an underlying junctional rhythm. After three days of lipid infusion, she no longer required inotropic agents to maintain blood pressure or pacing to maintain stable hemodynamics. Conclusions: Intravenous fat emulsion therapy may be an effective antidote for massive verapamil toxicity.
AB - Introduction. Massive intentional verapamil overdose is a toxic ingestion which can cause multiorgan system failure and has no currently known antidote. Case Presentation. The patient is a 41-year-old Caucasian woman who ingested 19.2 g of sustained release verapamil in a suicide attempt. Our patient became hypotensive requiring three high-dose vasopressors to maintain arterial pressure. She also developed acute respiratory failure, bradycardic ventricular rhythm necessitating continuous transvenous pacing, and anuric renal failure. Our patient was treated with intravenous calcium, bicarbonate, hyperinsulinemic euglycemic therapy and continuous venovenous hemodialysis without success. On the fourth day after hospital admission continuous intravenous lipid therapy was initiated. Within three hours of beginning lipid therapy, our patient's vasopressor requirement decreased by half. Within 24 hours, she was on minimal vasopressor support and regained an underlying junctional rhythm. After three days of lipid infusion, she no longer required inotropic agents to maintain blood pressure or pacing to maintain stable hemodynamics. Conclusions: Intravenous fat emulsion therapy may be an effective antidote for massive verapamil toxicity.
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U2 - 10.1186/1752-1947-5-399
DO - 10.1186/1752-1947-5-399
M3 - Article
C2 - 21854635
AN - SCOPUS:80051793322
SN - 1752-1947
VL - 5
JO - Journal of Medical Case Reports
JF - Journal of Medical Case Reports
M1 - 399
ER -