%0 Journal Article
%T Intoxication volontaire au v¨¦rapamil et au bisoprolol : ¨¤ propos d¡¯un cas Verapamil and bisoprolol self-poisoning: a case report
%A Campergue Jean-Baptiste
%A Narci Cl¨¦ment
%A Citterio-Quentin Antony
%A Faucher Etienne
%J Annales de Toxicologie Analytique
%D 2012
%I 
%R 10.1051/ata/2012007
%X Objectif : Le traitement de l¡¯hypertension art¨¦rielle primaire fait appel ¨¤ diff¨¦rents m¨¦dicaments cardiotropes aux effets toxiques comparables. Notre travail relate, chez un patient trait¨¦ pour hypertension, une double intoxication au v¨¦rapamil et au bisoprolol initialement ¨¦tiquet¨¦e bisoprolol seul, lors d¡¯un premier screening toxicologique large. Mat¨¦riel et m¨¦thodes : Le diagnostic de cette intoxication a ¨¦t¨¦ obtenu par la r¨¦p¨¦tition de recherches larges par une m¨¦thode CLHP/UV/BD. R¨¦sultats : La d¨¦couverte de l¡¯intoxication double au bisoprolol et au v¨¦rapamil a ¨¦t¨¦ permise grace ¨¤ deux screening toxicologiques successifs. Les concentrations toxiques de v¨¦rapamil sont apparues apr¨¨s la d¨¦croissance des concentrations toxiques de bisoprolol, expliquant la persistance, dans le temps, des sympt mes cardio-vasculaires. Cette intoxication a conduit le patient ¨¤ s¨¦journer en service de r¨¦animation m¨¦dicale pendant plusieurs jours. Les concentrations de v¨¦rapamil sont rest¨¦es toxiques pendant 6 jours. Conclusion : Devant l¡¯absence de modification des signes cliniques et la pr¨¦sence de forme gal¨¦nique ¨¤ lib¨¦ration prolong¨¦e, la r¨¦p¨¦tition d¡¯un screening toxicologique large plut t qu¡¯un dosage sp¨¦cifique du toxique initialement suspect¨¦, a permis le d¨¦pistage et le suivi d¡¯une intoxication poly-m¨¦dicamenteuse ¨¤ mol¨¦cules cardiotropes. Objective: Primary essential high blood pressure is treated by different cardiotropic drugs which have similar toxicological effects. Our study is about a verapamil and bisoprolol poisoning, which was at first labelled as bisoprolol only, after a comprehensive toxicological analysis. Materials and methods: This poisoning was diagnosed by repeated HPLC/UV/DAD screenings. Results: Two successive screenings showed both verapamil and bisoprolol poisoning. Verapamil toxic concentrations were revealed after the decrease in bisoprolol concentrations, explaining the persistence in time of cardiovascular symptoms. The patient stayed for several days in an intensive care unit. Verapamil concentrations remained at a toxic level for six days. Conclusion: Because of the presence of sustained-release forms and unchanged clinical signs, repeating a comprehensive toxicological screening, instead of monitoring the initially suspected drug, helped in the screening and the follow-up of this multiple cardiotopic drug poisoning.
%K V¨¦rapamil
%K bisoprolol
%K intoxication
%K CLHP
%K Verapamil
%K bisoprolol
%K poisoning
%K HPLC
%U http://dx.doi.org/10.1051/ata/2012007