Severe Atenolol and Diltiazem Overdose

Case Report: A case of combined, massive overdose of both atenolol and diltiazem in an adult male is reported. Cardiac arrest ensued which was responsive to cardiopulmonary resuscitation. Bradycardia, hypotension, and oliguria followed which were resistant to intravenous pacing and multiple pharmaco...

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Bibliographic Details
Published in:Journal of toxicology. Clinical toxicology 2000, Vol.38 (6), p.661-665
Main Authors: Snook, Curtis P., Snook, Curtis, Sigvaldason, Kristinn, Kristinsson, Jakob
Format: Article
Language:English
Subjects:
Adrenergic beta-Antagonists - blood
Adrenergic beta-Antagonists - poisoning
Adult
Atenolol - blood
Atenolol - poisoning
Biological and medical sciences
Calcium Channel Blockers - blood
Calcium Channel Blockers - poisoning
Diltiazem - blood
Diltiazem - poisoning
Drug Interactions
Drug intoxications. Doping
Drug Overdose
Heart Arrest - chemically induced
Heart Arrest - therapy
Humans
Male
Medical sciences
Pharmacology. Drug treatments
Suicide, Attempted
Treatment Outcome
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Summary:Case Report: A case of combined, massive overdose of both atenolol and diltiazem in an adult male is reported. Cardiac arrest ensued which was responsive to cardiopulmonary resuscitation. Bradycardia, hypotension, and oliguria followed which were resistant to intravenous pacing and multiple pharmacologic interventions, including intravenous fluids, calcium, dopamine, dobutamine, epinephrine, prenalterol, and glucagon. Adequate mean arterial pressure and urine output were restored only after addition of phenylephrine to therapy with multiple agents and transvenous pacing. The patient survived until discharge after a hospital course complicated by nontransmural myocardial infarct on hospital day 4 and pneumonia. Laboratory testing subsequently revealed high serum levels of both atenolol and diltiazem. The atenolol level of 35 μg mL in this patient is the highest reported associated with survival. Conclusion: This case illustrates severe cardiovascular toxicity after overdose of both atenolol and diltiazem. Oliguria, which has previously been reported in severe atenolol overdose, was successfully treated without hemodialysis by the addition of phenylephrine to aggressive therapy with pacing, inotropic, and pressor support.
ISSN:0731-3810
1097-9875
DOI:10.1081/CLT-100102018