A Case of Severe Verapamil Overdose

We report here on a 73-year-old woman who ingested 3.6 g (40 mg×90 tablets) of verapamil in a suicide attempt. On arrival, the patient was awake and well oriented. Two and a half hours after ingestion, she lost consciousness, as her heart rate and blood pressure began to decrease. Cardiac monitoring showed atrioventricular dissociation. Although she suffered from extreme hypotension, an echocardiogram revealed that the wall motion of the heart was almost normal, and cardiac output measured with a Swan-Ganz catheter was well preserved. The plasma verapamil concentration in this patient was 1499 ng/ml 4 h after ingestion. Hyperglycemia and hypokalemia, Iaboratory data revealed, continued for 18 h after admission. The patient was successfully resuscitated with intravenous saline, dopamine, and norepinephrine. Besides reporting on this case, we also report on a treatment for severe verapamil overdose. (Jpn Circ J 1998; 62: 72 - 76)