Third-degree AV block from extended-release diltiazem ingestion in a nine-month-old. J Emerg Med 2010 Apr;38(3):328-31
Date
04/12/2008Pubmed ID
18403171DOI
10.1016/j.jemermed.2007.10.053Scopus ID
2-s2.0-77949917332 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
Calcium channel blocker (CCB) overdose is associated with dysrhythmias and atrioventricular (AV) block, however, experience with infant CCB overdose is limited. A 9-month-old girl was found playing with tablets of extended-release diltiazem 120 mg. The patient had two episodes of emesis, which contained pill fragments, and was brought to the Emergency Department (ED) 4.5 h after being found. Vital signs were: rectal temperature 37.1 degrees C, pulse 87 beats/min, respiratory rate 30-40 breaths/min, blood pressure 72/48 mm Hg, and oxygen saturation (SpO(2)) 99% on room air. Otherwise, the patient was well-appearing, with normal skin color and examination. The electrocardiogram revealed third-degree atrioventricular block with a ventricular rate of 90 beats/min, QRS 68 ms, and QTc 411 ms. Atropine 0.1 mg i.v. was given, which increased the heart rate to 100-110 beats/min. Calcium gluconate 500 mg was also given intravenously. Laboratory evaluation revealed bicarbonate 17 mEq/L, anion gap 16, and glucose 129 mg/dL. On hospital day 1, the patient was noted to have a junctional rhythm with a rate of 90-100, and systolic blood pressure of 80-90 mm Hg. No additional medications were given. Early on day 2, the patient converted spontaneously to a normal sinus rhythm and was discharged approximately 42 h after presentation to the ED. In addition to bradycardia and hypotension, this 9-month-old patient manifested third-degree AV block after ingesting extended-release diltiazem.
Author List
Wills BK, Liu JM, Wahl MAuthor
Jason M. Liu MD Professor in the Emergency Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Atrioventricular BlockBradycardia
Calcium Channel Blockers
Diltiazem
Drug Overdose
Female
Humans
Hypotension
Infant