Levosimendan as Treatment Option in Severe Verapamil Intoxication: A Case Report and Review of the Literature

Cardiovascular shock due to verapamil intoxication is often refractory to standard resuscitation methods. Recommended therapy includes prevention of further absorption of the drug, inotropic therapy, calcium gluconate, and hyperinsulinemia/euglycemia therapy. Often further measures are needed such a...

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Main Authors: Mirjam Osthoff, Christine Bernsmeier, Stephan C. Marsch, Patrick R. Hunziker
Format: Article
Language:English
Published: Hindawi Limited 2010-01-01
Series:Case Reports in Medicine
Online Access:http://dx.doi.org/10.1155/2010/546904
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spelling doaj-a2200470369849a2addc3e9a03dc3e0c2020-11-24T21:08:06ZengHindawi LimitedCase Reports in Medicine1687-96271687-96352010-01-01201010.1155/2010/546904546904Levosimendan as Treatment Option in Severe Verapamil Intoxication: A Case Report and Review of the LiteratureMirjam Osthoff0Christine Bernsmeier1Stephan C. Marsch2Patrick R. Hunziker3Medical Intensive Care Unit, University Hospital Basel, 4031 Basel, SwitzerlandMedical Intensive Care Unit, University Hospital Basel, 4031 Basel, SwitzerlandMedical Intensive Care Unit, University Hospital Basel, 4031 Basel, SwitzerlandMedical Intensive Care Unit, University Hospital Basel, 4031 Basel, SwitzerlandCardiovascular shock due to verapamil intoxication is often refractory to standard resuscitation methods. Recommended therapy includes prevention of further absorption of the drug, inotropic therapy, calcium gluconate, and hyperinsulinemia/euglycemia therapy. Often further measures are needed such as ventricular pacing or mechanical circulatory support. Still, mortality remains high. Levosimendan, an inotropic agent, that enhances myofilament response to calcium, increases myocardial contraction and could therefore be beneficial in verapamil intoxication. Here, we report the case of a 60-year-old patient with clinically severe verapamil poisoning who presented with shock, bradycardia, and sopor. Standard therapy including high-dose inotropes failed to ameliorate the signs of intoxication. But additional therapy with levosimendan led to rapid improvement. Based on this observation, the literature is reviewed focusing on utilization of levosimendan in the treatment of calcium channel blocker overdose. We suggest to consider levosimendan as additional treatment option in patients with cardiovascular shock due to verapamil intoxication that are refractory to standard management.http://dx.doi.org/10.1155/2010/546904
collection DOAJ
language English
format Article
sources DOAJ
author Mirjam Osthoff
Christine Bernsmeier
Stephan C. Marsch
Patrick R. Hunziker
spellingShingle Mirjam Osthoff
Christine Bernsmeier
Stephan C. Marsch
Patrick R. Hunziker
Levosimendan as Treatment Option in Severe Verapamil Intoxication: A Case Report and Review of the Literature
Case Reports in Medicine
author_facet Mirjam Osthoff
Christine Bernsmeier
Stephan C. Marsch
Patrick R. Hunziker
author_sort Mirjam Osthoff
title Levosimendan as Treatment Option in Severe Verapamil Intoxication: A Case Report and Review of the Literature
title_short Levosimendan as Treatment Option in Severe Verapamil Intoxication: A Case Report and Review of the Literature
title_full Levosimendan as Treatment Option in Severe Verapamil Intoxication: A Case Report and Review of the Literature
title_fullStr Levosimendan as Treatment Option in Severe Verapamil Intoxication: A Case Report and Review of the Literature
title_full_unstemmed Levosimendan as Treatment Option in Severe Verapamil Intoxication: A Case Report and Review of the Literature
title_sort levosimendan as treatment option in severe verapamil intoxication: a case report and review of the literature
publisher Hindawi Limited
series Case Reports in Medicine
issn 1687-9627
1687-9635
publishDate 2010-01-01
description Cardiovascular shock due to verapamil intoxication is often refractory to standard resuscitation methods. Recommended therapy includes prevention of further absorption of the drug, inotropic therapy, calcium gluconate, and hyperinsulinemia/euglycemia therapy. Often further measures are needed such as ventricular pacing or mechanical circulatory support. Still, mortality remains high. Levosimendan, an inotropic agent, that enhances myofilament response to calcium, increases myocardial contraction and could therefore be beneficial in verapamil intoxication. Here, we report the case of a 60-year-old patient with clinically severe verapamil poisoning who presented with shock, bradycardia, and sopor. Standard therapy including high-dose inotropes failed to ameliorate the signs of intoxication. But additional therapy with levosimendan led to rapid improvement. Based on this observation, the literature is reviewed focusing on utilization of levosimendan in the treatment of calcium channel blocker overdose. We suggest to consider levosimendan as additional treatment option in patients with cardiovascular shock due to verapamil intoxication that are refractory to standard management.
url http://dx.doi.org/10.1155/2010/546904
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