Reactions Weekly | 2021
Verapamil
Abstract
Various toxicities following drug overdose in a suicide attempt: case report A 27-year-old woman developed emesis, hypotension, hypoxic respiratory failure, acute respiratory distress syndrome, cardiopulmonary arrest and noncardiogenic pulmonary oedema due to verapamil toxicity following intentional administration of verapamil at an overdose in a suicide attempt. The woman presented to the emergency department (ED) after 1 hour following intentional ingestion of verapamil 18000mg (overdose) in a suicide attempt. Her medical history was significant for asthma and depression. On presentation, she was alert but hypotensive. She was considered to have developed verapamil (Calcium channel blocker) toxicity. Therefore, the woman’s treatment was started with IV fluids, calcium, glucagon and activated charcoal. She had multiple episodes of emesis. She remained hypotensive. Then, she received norepinephrine, dobutamine and the high dose of insulin. However, she developed hypoxic respiratory failure and required mechanical ventilation. After intubation, she developed cardiopulmonary arrest due to pulseless electrical activity. Then, she received chest compression, atropine, bicarbonate and epinephrine during resuscitation. Ten minutes later, spontaneous circulation was achieved. Subsequently, she was transferred to another facility for higher level of care. Her hypoxemia was persistent on epoprostenol and cisatracurium-besilate. Then, her chest x-ray showed diffuse bilateral airspace opacities consistent with severe acute respiratory distress syndrome due to noncardiogenic pulmonary oedema. Thereafter, she received a trial of high dose unspecified diuretics, however, her oxygenation did not improve. Subsequently, a transthoracic echocardiogram showed adequate right and left ventricular function and normal end-diastolic filling pressure. Then, she was placed on a venovenous extracorporeal membrane oxygenation (VV-ECMO). Vasopressor and neuromuscular blocker were weaned off after 24 hours. Following 3 days on VV-ECMO, she was decannulated off ECMO. Her chest x-ray on day 3 and 5, showed improvement. She was extubated on day 6. After 7 days stay in ICU, she was shifted to the general ward. She stayed in the general ward for three more days. She was discharged from general ward with full recovery. She spent three more days at a psychiatric ward for her suicide attempt and depression.