@article{ref1,
title="Surprisingly delayed escalation of severe verapamil poisoning",
journal="European journal of emergency medicine",
year="2009",
author="Tuka, Vladimir and Ricarova, Bronislava and Janota, Tomas and Malik, Jan and Kotrlikova, Eva",
volume="16",
number="2",
pages="100-102",
abstract="We present a case report of intoxication by a potentially lethal dose of sustained-release verapamil with delayed escalation of complications. The patient was hospitalized 1.5 h after an attempted suicide with a very high dose of verapamil sustained-release (7.2 g). On admission the plasma concentrations were extremely high (3600 ng/l). Heart rate and blood pressure declined slowly with a surprising sudden escalation on the third day coupled with hemodynamic collapse and loss of consciousness. Complete recovery was achieved in spite of 2 h of extreme hypotension. We outline the clinical course, a need for massive bowel irrigation in case of sustained-release medication, the timing of a temporary pacing and the effect of centralization of circulation even on invasively measured blood pressure.<p /><p>Language: en</p>",
language="en",
issn="0969-9546",
doi="10.1097/MEJ.0b013e32830a997c",
url="http://dx.doi.org/10.1097/MEJ.0b013e32830a997c"
}