Reactions 1469, p42 - 14 Sep 2013

O SVerapamil/trandolapril overdose

Hypotension: case reportA 19-year-old woman developed hypotension following an

overdose of verapamil/trandolapril [Tarka Forte].The woman presented at an emergency clinic approximately

2 hours after ingestion of verapamil 2.4g/trandolapril 40mg(each tablet contains verapamil 240mg/trandolapril 4mg). Shereceived a nasogastric catheter, and underwent gastric lavagewith sodium chloride. She received active carbon, and wastransferred to an ICU. Following a decrease in her ionisedcalcium level, she received calcium chloride. Since her bloodglucose was over 256 mg/dL, she received insulin treatment. Acentral catheter was administered, and she underwenthaemoperfusion. Her BP had started to decreaseapproximately 4 hours after admission, and she starteddopamine. Due to continuing hypotension, dopamine wasincreased. She also received glucagon. She later received alipid solution, containing soya oil emulsion and medium chaintriglyceride. Two hours later, her systolic BP was 110 mm Hg,and dopamine treatment was decreased, then withdrawnwithin six hours. At follow-up, hypotension had resolved. Shewas discharged without sequelae.

Author comment: Intravenous lipid infusion is widelyaccepted for the treatment of lipophilic drug poisoning, suchas calcium channel blockers. . . it should be considered inparticular for the treatment of verapamil poisoning, not onlyin late phases but also in initial treatment.Akinci E, et al. Verapamil poisoning, the importance of intravenous lipid therapy:case report. Akademik Acil Tip Olgu Sunumlari Dergisi 4: 130-132, No. 3, 2013.Available from: URL: http://dx.doi.org/10.5505/jaemcr.2013.26349 [Turkish;summarised from a translation] - Turkey 803092834

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Reactions 14 Sep 2013 No. 14690114-9954/13/1469-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved