Cohen Victor, Jellinek Samantha P, Fancher Lydia, Sangwan Geetanjli, Wakslak Menachem, Marquart Elizabeth, Farahani Cyrus
Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York 11219, USA.
J Emerg Med. 2011 Mar;40(3):291-5. doi: 10.1016/j.jemermed.2008.10.015. Epub 2009 Feb 26.
Patients with fixed-dose combination product overdoses involving verapamil and trandolapril may present differently than sole calcium channel blocker (CCB) or angiotensin-converting enzyme inhibitor (ACE-I) overdose alone, and may have implications for the toxicological management. The ACE-I component may confound the traditional response to antidotal and supportive therapy recommended for CCB overdoses. In such cases, it may be prudent to manage the trandolapril component concurrently while administering traditional CCB antidotes.
To report a probable case and review the toxicological management of a fixed-dose antihypertensive combination product toxicity involving verapamil and trandolapril (Tarka®).
A 60-year-old man experienced dizziness and fell after ingesting five tablets of Tarka®. Eight hours later, he was found to be hypotensive and bradycardic. Therapy for CCB toxicity was initiated, including fluids, modified hyperglycemia-euglycemia insulin therapy, calcium chloride, activated charcoal, and glucagon. The patient's blood pressure and heart rate stabilized only after the administration and titration of dopamine and episodes of profuse vomiting in response to glucagon. The patient was transferred to the Cardiac Intensive Care Unit for further monitoring. He was considered stable to the point of all therapies being discontinued only 12 h post-ingestion. The patient was discharged 40 h after ingestion with no further sequelae.
Lack of familiarity with the components of fixed-dose combination products poses a problem during overdose situations and may confound the presentation and delay resuscitation and acute stabilization.
服用包含维拉帕米和群多普利的固定剂量复方制剂过量的患者，其表现可能与单独过量服用钙通道阻滞剂（CCB）或血管紧张素转换酶抑制剂（ACE-I）有所不同，这可能对毒理学处理有影响。ACE-I成分可能会混淆针对CCB过量推荐的解毒和支持治疗的传统反应。在这种情况下，在给予传统CCB解毒剂的同时，谨慎地同时处理群多普利成分可能是明智的。
报告一例可能的病例，并回顾涉及维拉帕米和群多普利（Tarka®）的固定剂量抗高血压复方制剂中毒的毒理学处理。
一名60岁男性在服用五片Tarka®后出现头晕并摔倒。八小时后，发现他血压过低且心动过缓。开始进行CCB中毒治疗，包括补液、改良的高血糖-正常血糖胰岛素疗法、氯化钙、活性炭和胰高血糖素。仅在给予多巴胺并滴定以及因胰高血糖素出现大量呕吐后，患者的血压和心率才稳定下来。患者被转至心脏重症监护病房进行进一步监测。仅在摄入后12小时，所有治疗停止时他被认为病情稳定。患者在摄入后40小时出院，无进一步后遗症。
在过量中毒情况下，对固定剂量复方制剂成分缺乏了解会带来问题，可能会混淆症状表现并延迟复苏和急性稳定治疗。
Zotero 插件