Nonocclusive Mesenteric Ischaemia Induced by Diltiazem Overdose: A Case Report

Abstract

Acute mesenteric ischaemia is a rare complication of calcium channel blocker (CCB) overdose. A previous study reported a case of mesenteric ischaemia induced by poisoning with CCBs other than diltiazem. We present a case of nonocclusive mesenteric ischaemia (NOMI) induced by diltiazem poisoning. Through this case report, we wish to emphasize that the clinicians should keep the possibility of intestinal ischaemia in mind from the early phase of calcium channel blocker poisoning. In addition, close monitoring and intense abdominal examination including the abdominal computed tomography scan should be done if CCBs poisoning patients complained of an abdominal pain.

Keywords

Calcium channel blockers colon drug overdose suicide vasodilator agents

References

Ramoska

E.A.

, Spiller

H.A.

, Winter

, Borys

. A one year evaluation of calcium channel blocker overdoses: toxicity and treatment. Ann Emerg Med 1993; 22(2): 196–200.

Perbet

, Constantin

J.M.

, Guérin

, Faure

, Brugère

, Da Inès

Non-occlusive colonic ischemia induced by verapamil ER overdose.

Intensive Care Med 2009; 35(5): 956–7.

Wax

P.M.

. Intestinal infarction due to nifedipine overdose. J Toxicol Clin Toxicol 1995; 33(6): 725–8.

Nault

J.C.

, Mégarbane

, Théodore

, Deye

, Nemeth

, Valleur

Poisoning-related bowel infarction: Characteristics and outcomes.

Clin Toxicol (Phila) 2009; 47(5): 412–8.

DeRoos

F.J.

. Calcium Channel blockers. In: Nelson

L.S.

, Lewin

N.A.

, Howland

M.A.

, Hoffman

R.S.

, Goldfrank

L.R.

, Flomenbaum

N.E.

, editors. Goldfrank's toxicologic emergencies. Ninth edition.

McGraw-Hill

2010; p 884–92.

Parks

D.A.

, Granger

D.N.

. Contributions of ischemia and reperfusion to mucosal lesion formation. Am J Physiol 1986; 250(6): 749–53.

Givertz

M.M.

, Fang

J.C.

. Approach to the patient with hypotension, and hemodynamic instability. In: Irwin

R.S.

, Rippe

M.J.

, eds. Irwin and Rippe's Intensive Care Medicine. Seventh edition.

Wolters Kluwer/Lippincott Williams & Wilkins

2012; p 307–17.

Todd

S.R.

, Turner

K.L.

, Moore

F.A.

. Shock: general. In: Gabrielli

, Layon

A.L.

, Yu

, eds. Civertta, Taylor, and Kirby's Critical Care. Fourth edition.

Wolters Kluwer/ Lippincott Williams & Wilkins

2009; p 813–34.

Dewitt

C.R.

. Calcium channel antagonist poisoning. In: Irwin

R.S.

, Rippe

M.J.

, eds. Irwin and Rippe's Intensive Care Medicine. Seventh edition.

Wolters Kluwer/ Lippincott Williams & Wilkins

2012; p 1403–9.

10.

Levine

, Curry

S.C.

, Padilla-Jones

, Ruha

A.M.

. Critical care management of verapamil and diltiazem overdose with a focus on vasopressors: a 25-year experience at a single center. Ann Emerg Med 2013; 62(3): 252–8.