Williamson K M, Dunham G D
School of Pharmacy, University of North Carolina, Chapel Hill 27599, USA.
Ann Pharmacother. 1996 Jun;30(6):608-11. doi: 10.1177/106002809603000608.
To describe the elimination of diltiazem and desacetyldiltiazem in an overdose situation.
An 18-year-old woman ingested controlled delivery diltiazem 14.94 g in a suicide attempt. After arriving at the hospital unresponsive and hypotensive, her condition progressed to complete heart block, cardiogenic shock, asystole, and acute renal failure. Supportive care consisted of vasopressors, intravenous calcium, intravenous glucagon, charcoal hemoperfusion, temporary transvenous pacing, and an intraaortic balloon pump. After 12 days in the hospital, the patient recovered fully.
We report a large, documented overdose of diltiazem and detail the pharmacokinetic profiles of both diltiazem and its active metabolite, desacetyldiltiazem. Nonlinear elimination of diltiazem appears to occur at higher concentrations. Although the patient improved clinically following charcoal hemoperfusion, no dramatic effects on diltiazem elimination were apparent.
Survival following massive diltiazem overdose can be achieved with supportive care. Charcoal hemoperfusion had a limited effect on improving the clearance of diltiazem as evidenced by serial plasma concentrations.
描述在过量用药情况下地尔硫䓬及其脱乙酰代谢产物的清除情况。
一名18岁女性为自杀企图服用了控释型地尔硫䓬14.94克。到达医院时她无反应且血压过低，随后病情发展为完全性心脏传导阻滞、心源性休克、心脏停搏及急性肾衰竭。支持性治疗包括使用血管升压药、静脉注射钙剂、静脉注射胰高血糖素、活性炭血液灌流、临时经静脉起搏及主动脉内球囊反搏。住院12天后，患者完全康复。
我们报告了一例有记录的大量地尔硫䓬过量用药病例，并详细阐述了地尔硫䓬及其活性代谢产物脱乙酰地尔硫䓬的药代动力学特征。地尔硫䓬在较高浓度时似乎会出现非线性清除。尽管患者在活性炭血液灌流后临床症状有所改善，但对地尔硫䓬的清除并无明显显著效果。
通过支持性治疗可实现大量地尔硫䓬过量用药后的存活。连续血浆浓度表明，活性炭血液灌流在改善地尔硫䓬清除率方面作用有限。
