The American journal of the medical sciences
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Review Case Reports
Massive overdose of sustained-release verapamil: a case report and review of literature.
Verapamil 99 is a commonly prescribed medicine for treatment of hypertension, angina, and migraine headache. Toxicity with sustained-release verapamil may be prolonged, and manifest with hypotension, bradycardia, metabolic acidosis, and hyperglycemia. Currently, because of the lack of a specific antidote management of verapamil, toxicity is mainly supportive. ⋯ The patient was managed aggressively with gastric lavage, inotropic support, and continuous infusion of calcium and glucagon. The patient's survival may have been due to the continuous intravenous calcium gluconate and glucagon infusion. Both of these treatment modalities should be considered in patients with moderate to severe calcium channel blocker overdose.
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Serum lipoproteins are important risk factor variables for coronary artery disease (CAD). Studies of a large population of young individuals show changes in lipoproteins in childhood are race- (black-white) and sex-specific and certain changes occur during growth phases. White boys show adverse changes in lipoprotein levels during sexual maturation that mark them at high risk for CAD. ⋯ Clustering of increased levels of truncal fat, insulin, and blood pressure is often seen in young adults with an adverse lipoprotein profile. This clustering is related to subtle abnormalities in carbohydrate and lipid metabolism and obesity in childhood. The fact that lipoprotein levels persist from childhood to young adulthood underscores the importance of detection and management of dyslipidemia early in life.
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Hypertension occurs at an earlier age, is more prevalent, and is more often complicated by target organ damage in African-Americans than whites. Reasons for this increased severity of hypertension in African-Americans remain obscure. Based on studies recently completed in their laboratory, the authors propose that greater sympathetic reactivity to stress and a greater prevalence of NaCl sensitivity contribute to the earlier development of hypertension in African-Americans. ⋯ Using a telemetry-based monitoring system, the authors recently reported that both spontaneously hypertensive rats and normotensive Wistar-Kyoto rats manifest acute sensitivity to high dietary NaCl ingestion, but that the Wistar-Kyoto rats are able to compensate, thereby avoiding sustained increases in blood pressure. Based on these animal studies, it is proposed that elevated nocturnal pressures observed in blacks by other investigators may reflect the greater prevalence of NaCl sensitivity in the black population. As in animal models of NaCl-sensitive hypertension, blacks may retain ingested NaCl, resulting in sustained increases in blood pressure.