Erickson F C, Ling L J, Grande G A, Anderson D L
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
J Emerg Med. 1991 Sep-Oct;9(5):357-66. doi: 10.1016/0736-4679(91)90380-x.
We present a case of diltiazem overdose in which the patient ingested 4.2 grams in an apparent suicide attempt. He arrived in the emergency department two hours postingestion with a blood pressure of 60/40 torr and a heart rate of 62 beats/min in a junctional rhythm. Intervention included activated charcoal, gastric lavage, intravenous fluids, calcium (both chloride and gluconate), dopamine, and atropine with improvement in vital signs. Diltiazem levels were obtained and half-life calculated. This ingestion is one of the largest reported in the literature and is remarkable in that the patient recovered without pacing or other extraordinary measures. All eight previously published cases of diltiazem overdose, including all unpublished reports to the manufacturer, are reviewed and their management strategies examined. Successful treatment in which recovery has occurred in less than 48 hours, includes pressors, calcium, glucagon, pacing, and charcoal hemoperfusion. A strategy for emergency physicians to use when approaching this problem is suggested from the review.
我们报告一例地尔硫䓬过量病例，患者摄入4.2克该药，显然是企图自杀。摄入药物两小时后，他被送往急诊科，血压为60/40托，心率62次/分钟，呈交界性心律。干预措施包括使用活性炭、洗胃、静脉输液、钙剂（氯化钙和葡萄糖酸钙）、多巴胺和阿托品，生命体征有所改善。检测了地尔硫䓬水平并计算了半衰期。此次摄入是文献报道中摄入量最大的案例之一，值得注意的是，患者未经起搏或其他特殊措施治疗便康复了。我们回顾了此前发表的所有8例地尔硫䓬过量病例，包括向制造商提交的所有未发表报告，并研究了其治疗策略。成功的治疗方法（患者在48小时内康复）包括使用升压药、钙剂、胰高血糖素、起搏和活性炭血液灌流。通过此次回顾，为急诊医生处理此类问题提供了一种策略。
