A Fatal Case of Massive Verapamil Overdose: An Overview of the Treatment Options

Francis Atemnkeng, Jawad Shabani, Lu Chen, Bhavesh Gala, Jonathan Ramalho, Keith Diaz, Jay Nfonoyim

Abstract


Calcium channel blocker overdose is usually very fatal and challenging to manage. The patients are usually asymptomatic on admission, but deteriorate very rapidly. Currently, there is no specific antidote, and the treatment is supportive requiring high level of critical care, and may necessitate extracorporeal membrane oxygenation. The use of high-dose insulin is reported to help stabilize the blood pressure and wean off inotropes. The recommendations for supportive treatment in patients with calcium channel blocker overdose are based upon low-quality evidence reports including case series and animal studies. We present the case of a 55-year-old male with a history of atrial fibrillation who was admitted to the hospital 30 min after intentionally ingesting 80 tablets of 180 mg extended release verapamil. On admission, the patient was asymptomatic, but electrocardiogram (ECG) showed a complete heart block which necessitated a transcutaneous pacing, followed by transvenous pacemaker placement. Rapid deterioration of the patient’s hemodynamic status led to the patient getting intubated and was started on pressors as well as high-dose insulin. Despite all the aggressive measures, the patient died in less than 24 h after being admitted. We report this case to provide a brief review of the treatment options available at this time, because to date, there is no specific antidote for such overdose, and it remains very fatal despite the amount of supportive care provided.




J Med Cases. 2021;12(9):373-376
doi: https://doi.org/10.14740/jmc3763

Keywords


Calcium channel blocker overdose; Verapamil overdose; Antidote; Atrioventricular dissociation; High-dose insulin

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