Three recent cases illustrate the potential of lipid therapy in calcium channel blocker overdose. Young et al. present a case of multidrug overdose including 13.44 g of verapamil in combination with bupropion, zolpidem, quetiapine, clonazepam and benazepril [26]. Their patient presented to the hospital hypotensive and acidotic, requiring mechanical ventilation and norepinephrine to maintain arterial pressure. Lipid therapy was initiated almost immediately upon arrival, and within an hour the norepinephrine dose was halved. The patient was extubated on day two, and discharged on day five with no neurologic deficits. Montiel et al. describe a second case of a patient who ingested 3.6 g of sustained-release diltiazem who was treated with hyperinsulinemic euglycemia therapy in combination with lipid therapy [27]. Their patient had an improvement in blood pressure within one hour of beginning intravenous lipid, and was discharged from the intensive care unit on day nine with a full recovery. Finally, French et al. report a case of sustained verapamil overdose treated with lipid emulsion therapy. Notably, the serum level of verapamil in their case was slightly decreased after administration of lipids [28].
100 Cases By Conrad Fischer.pdf
2ff7e9595c
Comments