• Am J Emerg Med · Oct 2017

    Case Reports

    Massive diltiazem and metoprolol overdose rescued with extracorporeal life support.

    • James A Chenoweth, Daniel K Colby, Mark E Sutter, Joshua B Radke, Jonathan B Ford, J Nilas Young, and John R Richards.
    • Department of Emergency Medicine, Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, CA, United States; Division of Toxicology, Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, CA, United States. Electronic address: jachenoweth@ucdavis.edu.
    • Am J Emerg Med. 2017 Oct 1; 35 (10): 1581.e3-1581.e5.

    AbstractThe management of overdoses of cardioactive medications in the emergency department can be challenging. The reversal of severe toxicity from one or more types of cardioactive medication may fail maximal medical therapies and require extreme invasive measures such as transvenous cardiac pacing and extracorporeal life support. We present a case of massive diltiazem and metoprolol overdose refractory to maximal medical therapy, including intravenous calcium, glucagon, vasopressors, high dose insulin, and lipid emulsion. The patient experienced refractory bradydysrhythmia that responded only to transvenous pacing. Extracorporeal life support was initiated and resulted in successful organ perfusion and complete recovery of the patient. This case highlights the potential utility of extracorporeal life support in cases of severe toxicity due to multiple cardioactive medications.Copyright © 2017 Elsevier Inc. All rights reserved.

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