Massive diltiazem overdose treated with extracorporeal membrane oxygenation

Durward, Andrew; Guerguerian, Anne‐Marie; Lefebvre, Marc; Shemie, Sam D.

doi:10.1097/01.pcc.0000074273.50306.f5

Cited by 80 publications

(44 citation statements)

References 19 publications

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“…These early studies showed improved mortality in models of lidocaine and amitriptyline poisoning [11,12]. Numerous human case reports and case series have since shown favorable outcomes although ECMO has been primarily used in poisonings involving pharmaceuticals such as antidysrhythmics and other cardiovascular medications, as well as tricyclic antidepressants [13][14][15][16][17][18][19][20][21][22][23][24][25]. Many of the pharmaceutical exposures in our cohort were similar to cases reported in the literature with most leading to cardiotoxicity or hemodynamic collapse (flecainide, diphenhydramine, and verapamil).…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

et al. 2015

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Although there have been many developments related to specific strategies for treating patients after poisoning exposures, the mainstay of therapy remains symptomatic and supportive care. One of the most aggressive supportive modalities is extracorporeal membrane oxygenation (ECMO). Our goal was to describe the use of ECMO for toxicological exposures reported to the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (Tox-IC). We performed a retrospective review of the ACMT ToxIC Registry from January 1, 2010 to December 31, 2013. Inclusion criteria included patients aged 0 to 89 years, evaluated between January 2010 through December 2013, and received ECMO for toxicological exposure. There were 26,271 exposures (60 % female) reported to the ToxIC Registry, 10 (0.0004 %) received ECMO: 4 pediatric (< 12 years), 2 adolescent (12-18 years), and 4 adults (>18 years). Time of initiation of ECMO ranged from 4 h to 4 days, with duration from 15 h to 12 days. Exposures included carbon monoxide/smoke inhalation (2), bitter almonds, methanol, and several medications including antihistamines (2), antipsychotic/ antidepressant (2), cardiovascular drugs (2), analgesics (2), sedative/hypnotics (2), and antidiabetics (2). Four ECMO patients received cardiopulmonary resuscitation (CPR) during their hospital course, and the overall survival rate was 80 %. ECMO was rarely used for poisoning exposures in the ACMT ToxIC Registry. ECMO was utilized for a variety of ages and for pharmaceutical and non-pharmaceutical exposures. In most cases, ECMO was administered prior to cardiovascular failure, and survival rate was high. If available, ECMO may be a valid treatment modality.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

et al. 2015

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“…Because the treatment protocol for calcium channel blocker intoxication is supported by low-quality evidence, the treatment regimen is determined according to the severity of symptoms, including high-dose insulin, intravenous calcium gluconate injection, intravenous glucagon injection, intravenous vasopressor infusion and lipid emulsion therapy (5). Furthermore, it has been reported that extracorporeal life support is associated with a survival benefit in the setting of multiorgan dysfunction, severe shock and/or cardiac arrest after diltiazem overdose (5,(10)(11)(12). Although our patient was managed conservatively, his clinical course was uneventful and the serum diltiazem concentration decreased on day 3 (35.9 ng/mL).…”

Section: Discussionmentioning

confidence: 89%

Ischemic Acute Tubular Necrosis due to Diltiazem Overdose

et al. 2016

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Diltiazem overdose has a high mortality rate due to cardiotoxicity associated with bradycardia and hypotension. A previous article reported that this type of overdose can cause acute tubular necrosis, which was not pathologically, but rather clinically, diagnosed. We herein report the case of a 55-year-old man who sustained nonoliguric acute kidney injury after taking 60 diltiazem tablets. A kidney biopsy performed six days after admission showed ischemic, not toxic, acute tubular necrosis. The patient's kidney function improved spontaneously. In this case report, we clarify the cause of renal impairment caused by diltiazem overdose pathologically. Physicians should therefore consider ischemic acute tubular necrosis as a cause of kidney injury in patients with diltiazem overdose.

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“…La paciente del caso reportado con intoxicación intencional por amlodipino, cursó con choque vasodilatado y disfunción multiorgánica, acidosis metabólica, azoemia, edema pulmonar no cardiogenico, sin evidencia de bradiarritmia y depresión miocárdica, cuadro clínico y hemodinámico similar a los reportados previamente (6)(7)(8). El manejo incluyó soporte con ventilación mecánica, solución salina 0,9%, vasopresores múltiples a dosis por encima de las habituales para lograr estabilidad, gluconato de calcio, bicarbonato de sodio, dextrosa 10% con insulina regular (3,5,(7)(8)(9); no se usó glucagón por no tener disponibilidad.…”

Section: Discussionunclassified

Amlodipino y choque vasodilatado en una unidad de cuidados intensivos de un hospital general. Reporte de caso

Zegarra¹,

Meza²,

Cornejo³

et al. 2017

Rev Med Hered

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Massive diltiazem overdose treated with extracorporeal membrane oxygenation

Abstract: Although massive calcium channel blocker overdose can produce profound and prolonged cardiac or multiorgan dysfunction, its toxic effects may be reversible. Supportive therapy, particularly of the cardiovascular system, is the most important goal.

Cited by 80 publications

References 19 publications

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

Ischemic Acute Tubular Necrosis due to Diltiazem Overdose

Amlodipino y choque vasodilatado en una unidad de cuidados intensivos de un hospital general. Reporte de caso

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