Abstract
Long-acting diltiazem preparations are currently frequently prescribed, and the potential for serious morbidity and mortality 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 beats/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.
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