Reactions 829 - 25 Nov 2000

O SVerapamil/trandolapril overdose

Rhabdomyolysis, renal failure and hypotension:case report

Verapamil and trandolapril overdose resulted inrhabdomyolysis, acute renal failure and hypotension in a28-year-old man.

The man had taken 4 tablets, each containing verapamil180mg and trandolapril 2mg (total dose of verapamil 720mgand trandolapril 8mg). 10 hours later, he had becomecomatose and he was hospitalised. His BP was 60/40mm Hg,his temperature was 36.2°C and he was unresponsive to deeppain. He was treated with thiamine and an infusion of sodiumchloride and dextrose. 10 minutes later, his BP was 70/40mmHg and he became responsive to deep pain. He was treatedwith orogastric lavage, followed by activated charcoaladministration. An ECG identified junctional bradycardia of 60beats/min. 30 minutes after admission to hospital, dopaminewas started to increase his BP. His creatinine and lactatedehydrogenase levels were 486 µmol/L and 300 U/L,respectively.

One hour after dopamine was started, the man’s BP hadincreased to 80/40mm Hg and his HR had increased to 96beats/min. He had awoken 4 hours after admission to hospital,but he had diffuse muscle cramps and myalgia. Four hourslater his creatinine level was 565 µmol/L, his creatine kinaselevel was 10 700 U/L and his BUN level had increased to 13.2mmol/L. Urinalysis revealed the presence of pigmented,muddy brown granular casts, erythrocytes and tubularepithelial cells.

The man’s laboratory values had changed little 24 hoursafter hospitalisation. After a further 24 hours, his BP hadincreased to 90/50mm Hg, his HR was 100 beats/min and hisBUN and creatinine levels had decreased slightly. Dopaminewas stopped at that time. On hospital day 4, his BP was90/60mm Hg, his creatine kinase level had decreased to 3920U/L and his creatinine and BUN levels were normal, as werethe results of an ECG. However, his AST and ALT levels hadbecome elevated at 136 and 121 U/L, respectively. Six daysafter hospitalisation, his BP was 100/70mm Hg, but his ASTand ALT levels remained elevated.

Author comment: ‘In our patient ARF [acute renal failure]developed secondary to rhabdomyolysis . . . Rhabdomyolysismust be considered in patients with myalgias and musclecramps receiving verapamil-trandolapril treatment and routineserum CK [creatine kinase] levels should be checked on.’Gokel Y, et al. High-dose verapamil-trandolapril induced rhabdomyolysis andacute renal failure. American Journal of Emergency Medicine 18: 738-739, Oct2000 - Turkey 800848882

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Reactions 25 Nov 2000 No. 8290114-9954/10/0829-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved