Severe pulmonary complications of massive intoxication with calcium channel blockers and isosorbide mononitrate--a case report

A 22-year-old man was admitted to the acute intoxication unit after suicidal intoxication with 100 tablets of verapamil, diltiazem and isosorbide mononitrate. He developed shock, paralytic ileus and adult respiratory distress syndrome (ARDS). The patient required high doses of catecholamines and mec...

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Published inPrzeglad lekarski Vol. 61; no. 4; p. 405
Main Authors Magdalan, Jan, Antończyk, Andrzej, Kowalski, Krzysztof, Przewłocki, Michał, Kochman, Krystyna, Wasylko-Smolarek, Małgorzata
Format Journal Article
LanguagePolish
Published Poland 2004
Subjects
Adult
Calcium Channel Blockers - poisoning
Diltiazem - poisoning
Humans
Isosorbide Dinitrate - analogs & derivatives
Isosorbide Dinitrate - poisoning
Male
Respiratory Distress Syndrome, Adult - chemically induced
Respiratory Distress Syndrome, Adult - therapy
Suicide, Attempted
Treatment Outcome
Vasodilator Agents - poisoning
Verapamil - poisoning
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Summary:A 22-year-old man was admitted to the acute intoxication unit after suicidal intoxication with 100 tablets of verapamil, diltiazem and isosorbide mononitrate. He developed shock, paralytic ileus and adult respiratory distress syndrome (ARDS). The patient required high doses of catecholamines and mechanical ventilation with high inspiratory pressure. Pulmonary barotrauma (pneumothorax, pneumomediastinum, pneumoperitoneum and soft tissue emphysema) was a secondary complication to mechanical ventilation. It is well known that alveolar epithelial type II cells synthesize and secrete all components of the surfactant. Surfactant secretion in epithelial type II cells is inhibited by calcium channel blockers and it predisposes to develop ARDS. This case illustrates the possibility of ARDS in the verapamil and diltiazem intoxication and the need for a heightened awareness of this potential complication.
ISSN:0033-2240