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Table 2 Fatal cases

From: Outcomes following calcium channel blocker exposures reported to a poison information center

Gender and age Comorbidity Anamnestic drug exposure (doses noted if known) Interval to presentation and death post intake Clinical presentation at hospital
Time from intake to admission if known) and symptoms (GCS, temperature, hemodynamic, renal, other
Paraclinical parameters
Arterial blood gas (pH, base excess, lactate) blood samples (e.g. glucose, calcium,) and ECGs
Treatment
Gastrointestinal decontamination (e.g. gastric emptying, activated charcoal).
Inotropes, vasopressors and vasoactive therapy (e.g. isoprenaline, norepinephrine).
Other interventions (e.g. dialysis, calcium, glucagon)
Female, 82 y Morbus Meniere.
Cardiovascular disease.
Several previous suicidal attempts.
Verapamil 24,000 mg (as extended release tablets 240 mg)
Escitalopram 280 mg
3 days 12 h after intake:
Somnolent.
BP 80/35 mmHg, HR 35 increasing to 50.
Anuria.
Muscle twitches and cramps in the extremities.
ABG: pH 7.33, BE −10.8, lactate 1,6–3,2 mmol/l.
P-glucose 9.1 mmol/l,
P-calcium (ion)1.17 mmol/l
Increasing creatinine
ECG: Initially AV nodal rhythm, atrial fibrillation with LBBB
Gastric aspiration (without lavage) without any tablets retrieved. Activated charcoal - single dose.
Atropine, Isoprenaline, norepinephrine (up to 0.56 μg/kg/minute), epinephrine (up to 0.4 μg/kg/minute).
Levosimendan.
Other: Plasmapheresis and CRRT, temporary pacemaker (bradycardia), non-invasive ventilation due to carbon dioxide retention
Male, 49 y Anxiety Periodic Depression, Epilepsy. Verapamil (as extended release tablets 240 mg)
Quetiapine
Codeine
Acetaminophen
Tramadol Topiramate
2 h Within 12 h after intake:
GCS 3. Temperature 32,5 °C. Seizure in ambulance,
BP low, cold and pale.
Low urine production.
ABG: pH 6.88, lactate 11.3 mmol/L.
ECG: ST-depression V2-V6 turning into first bradycardia, then PEA and finally cardiac arrest.
Gastric aspiration (without lavage) with small amounts of tablets retrieved. Activated charcoal - single dose.
Endotracheal intubation
Atropine, epinephrine, norepinephrine, phenylephrine,
Other: Sodium bicarbonate, calcium, dobutamine, naloxone
After PEA: Glucagon, amiodarone, infusion with insulin-glucose (high dose).
Female 76 y Obesity.
COPD.
Arterial hypertension.
Anxiety disorder, Several previous suicidal attempts.
Verapamil
Acetaminophen ozaxepam
12 h Time unknown. Admission status:
GCS 9. Temperature 32,7 °C.
BP 80/50 mmHg, HR 40 initially increases to 65.
AKI.
Myoglobin 1167 μg/L.
ABG: pH 7.2, BE 3, lactate 2.4 mmol/L
P-glucose 16,1 mmol/L
ECG: Bradycardia, 3rd degree AV-block, asystole turning into cardiac arrest.
(GID not performed)
Atropine, isoprenaline, norepinephrine (up to 0.7 μg/kilo/minute), epinephrine (0.4 μg/kilo/minute).
Other: Flumazenil, N-acetylcysteine, calcium, dopamine, sodium bicarbonate, naloxone.
Female 63 y Unknown. Amlodipine 425 mg,
Metoprolol 4250 mg Enalapril
2 days 6 h after intake:
Comatose.
MAP 50, HR 44 (SR), cold.
Anuria.
ABG: pH 7.1, BE-19.8, lactate 17 mmol/L.
ECG: Atrioventricular Junctional Rhythm (25–40 bpm)
Gastric aspiration (without lavage) with unknown result. Activated charcoal - single dose.
Endotracheal intubation, controlled ventilation with high oxygen demand.
Atropine, norepinephrine, epinephrine, isoprenaline. Levosimendan, Other: temporary pacemaker, calcium infusion, glucagon, intravenous lipid emulsion.
Dialysis.
Female, 61 y COPD.
Depression.
Multiple previous suicide attempts.
Verapamil 6000 mg
Ramipril 150 mg Ibuprofen 20 g
Zolpidem 200 mg
2 Time unknown. Admission status:
Unconscious. Reacts to pain. Mumbles. Temperature 34,2 °C.
BP 60/ 35, HR 36, cold, pale and sweaty.
Anuria.
ABG: pH 7.26, BE − 6,8, lactate 11.1 mmol/L
ECG: Wide QRS-complexes.
Activated charcoal - single dose.
Endotracheal intubation.
Atropine isoprenaline, noradrenaline, adrenaline, dopamine, ephedrine.
Other: temporary pacemaker, calcium, glucagon,
Calcium (bolus and infusion), glucagon, insulin, flumazenil.
Dialysis.
After temperature increases to 39 °C: Tazobactam/piperacillin, ciprofloxacin, metronidazole.
Male, 83 y Paranoid psychosis
Cerebral infarction
Dementia
Arterial hypertension.
Aortic valve insufficiency.
Felodipine
(as 5 mg tablets)
Acetaminophen 10 g
Baclofen
Quinine 4 g, Acetylsalicylic acid (as 75 mg tablets)
8 days Time unknown. Admission status:
Somnolence.
BP 111/45, HR 77
Urine production.
ABG: pH 7.24, BE 8
P-creatinine: 207 mmol/L
P-calcium (ion): 0,96
ECG: 1st degree AV block,
Right bundle branch block (pre-existing) (
(GID nor performed).
adrenalin, noradrenalin
Endotracheal intubation.
Other: calcium, sodium bicarbonate, N-acetylcysteine.
Furosemide, labetalol.
Symptomatic treatment (morphine, diazepam)
Male, 30 y Depression Hypertension Amlodipine (as 10 mg tablets)
Acetylsalicylic acid
(as 75 mg tablets)
Ramipril
12 h Time unknown. Admission status:
Awake and fully aware of the situation. Nausea and sweaty – otherwise as usual.
P-salicylate 0.4 mmol/L
ECG: Normal
No further test - patient leaves the hospital.
Activated charcoal - single dose.
Patient leaves the hospital before any other treatment is started. The patient dies 12 h later of carbon monoxide poisoning.
  1. Abbreviations: ABG Arterial Blood Gas, COPD Chronic Obstructive Pulmonary Disease, CRRT Continous Renal Replacement Therapy, ECG ElectroCardioGram, GCS Glasgow Coma Score, BE Base Excess, LBBB Left Bundle Branch Blockade, GID Gastrointestinal Decontamination