%0 Journal Article
%T Severe Diltiazem Poisoning Treated with Hyperinsulinaemia-Euglycaemia and Lipid Emulsion
%A Nadine Monteiro
%A Joana Silvestre
%A Jo£¿o Gon£¿alves-Pereira
%A Camila Tapadinhas
%A Vitor Mendes
%A Pedro P¨®voa
%J Case Reports in Critical Care
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/138959
%X Introduction. Calcium channel blockers (CCBs) drugs are widely used in the treatment of cardiovascular diseases. CCB poisoning is associated with significant cardiovascular toxicity and is potentially fatal. Currently, there is no specific antidote and the treatment of CCB poisoning is supportive; however, this supportive therapy is often insufficient. We present a clinical case of severe diltiazem poisoning and the therapeutic approaches that were used. Case Report. A 55-year-old male was admitted to the intensive care unit (ICU) after voluntary multiple drug intake, including extended release diltiazem (7200£¿mg). The patient developed symptoms of refractory shock to conventional therapy and required mechanical ventilation, a temporary pacemaker, and renal replacement therapy. Approximately 17 hours after drug intake, hyperinsulinaemia-euglycaemia with lipid emulsion therapy was initiated, followed by progressive haemodynamic recovery within approximately 30 minutes. The toxicological serum analysis 12£¿h after drug ingestion revealed a diltiazem serum level of 4778£¿ng/mL (therapeutic level: 40¨C200£¿ng/mL). Conclusions. This case report supports the therapeutic efficacy of hyperinsulinaemia-euglycaemia and lipid emulsion in the treatment of severe diltiazem poisoning. 1. Introduction Diltiazem is a nondihydropyridine L-type calcium channel blocker (CCB) which is widely used in the treatment of cardiovascular diseases. The prescription of CCB has increased significantly in recent years, [1, 2] and concomitantly the number of cases of voluntary and involuntary poisoning. In 2011, the American Association of Poison Control Centers reported 1995 deaths from exposure to toxic substances, 1689 of which were from medications (84.7%) [3]. Following analgesics and antidepressants, cardiovascular drugs were the most often involved. Of these drugs, CCB were most commonly used [3]. Calcium channel blockers overdose can cause life-threatening effects, such as bradycardia, atrioventricular (AV) block, hypotension, metabolic acidosis, and shock that is often refractory to conventional therapy. The treatment of CCB poisoning has been limited to organ support measures. The importance of hyperinsulinaemia-euglycaemia and lipid emulsion therapy has recently been recognised in the treatment of these patients [4¨C12]. Traditionally, these approaches are used as late salvage therapy in cases of CCB poisoning when other measures have failed. We hereby present a clinical case of a patient with severe diltiazem poisoning in which hyperinsulinaemia-euglycaemia and lipid emulsion
%U http://www.hindawi.com/journals/cricc/2013/138959/