Abstract
We present a case report of intoxication by a potentially lethal dose of sustained-release verapamil with delayed escalation of complications. The patient was hospitalized 1.5 h after an attempted suicide with a very high dose of verapamil sustained-release (72 g).
On admission the plasma concentrations were extremely high (3600 ng/l). Heart rate and blood pressure declined slowly with a surprising sudden escalation on the third day coupled with hemodynamic collapse and loss of consciousness.
Complete recovery was achieved in spite of 2 h of extreme hypotension. We outline the clinical course, a need for massive bowel irrigation in case of sustained-release medication, the timing of a temporary pacing and the effect of centralization of circulation even on invasively measured blood pressure.
European Journal of Emergency Medicine 16:100-102 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.