Massive overdose of Cardizem CD

Long-acting diltiazem preparations are currently frequently prescribed, and the potential for serious morbidity and morbidity with an overdose can be significant. We present a case of Cardizem CD overdose in which a 22-year- old patient ingested 18.0 g, in an apparent suicide attempt. She presented within 5 hours of ingestion with a blood pressure of 80/30 mm Hg and a pulse of 80 heats/minute. Interventions included intravenous fluids, activated charcoal, atropine, calcium, dopamine, norepinephrine, glucagon, bowel irrigation with polyethylene glycol, and placement of a temporary transvenous pacemaker. Diltiazem levels were obtained, and an elimination half-life was calculated. Unique side effects of this overdose are discussed, and a treatment approach is suggested. Early and aggressive treatment is essential, and preparation for anticipated side effects should be initiated as soon as possible.

Duke Scholars

Author Richard Clinton Becker Medicine, Cardiology