![]() Then, norepinephrine infusion therapy (0.1 mcg/kg/min) was started because she had peripheral vasodilatation symptoms and flushing. She was in cardiogenic shock and dopamine infusion, at a rate of 10 mcg/kg/min was started, and calcium gluconate was given for CCB toxicity but her vital parameters did not change. In our follow-up, her general condition was poor and lethargic bradycardia and ventricular extrasystoles were seen in the ECG. Hyperglycemia was not found in the patient's blood glucose monitoring. In the laboratory analyses, complete blood count, renal function tests, serum electrolytes, and arterial blood gas analyses were taken, and all the results were within normal limits apart from elevated lactate levels (5.2 mml/L). A central venous catheter was inserted quickly and 2500 ml/m2 hydration was started. The patient was taken to the PICU because her bradycardia and hypotension were resistant despite treatment. 20 ml/kg 0.9% saline infusion has been given to the patient two times in the emergency department. In the emergency department, gastric lavage and active charcoal treatment were not performed because she received the drug 10 h before the admission. She was lethargic, her arterial blood pressure (BP), heart rate, respiration rate, and body temperature were measured as 57/32 mmHg, 50/min, 14/min, and 36.2☌, respectively. On her physical examination, her body weight was 60 kg and her height was 157 cm. Her serial electrocardiography (ECGs) were obtained. The patient underwent continuous cardiac monitoring. The patient stated that she had ingested 40 tablets verapamil (contains 120 mg verapamil hydrochloride in each tablet) 10 h before the emergency service admission. Case ReportĪ 14-year-old girl was admitted to the pediatric emergency room with complaints of vomiting and dizziness. Here, we would like to report the early use of ILE therapy in verapamil intoxication in a 14-year-old girl who was followed with resistant hypotension and bradycardia in our pediatric intensive care unit (PICU). Intravenous calcium supplements, glucagon, hyperinsulinemic euglycemia (HIE) treatment, and in recent years, lipid emulsion therapy are recommended treatment methods in verapamil intoxication. Gastrointestinal decontamination is the first-line therapy. In verapamil intoxication, there is no known antidote. Metabolic acidosis and hyperglycemia are other common symptoms. Hypotension and bradycardia are the most common symptoms in CCB intoxication. ILE therapy began to be used for therapeutic purposes in the systemic toxicity of local anesthetic drugs in 2006, and then it was used for lipophilic drug toxicity, and successful results have been reported in intoxications with calcium channel blockers (CCBs), beta-blockers, neuroleptics, antidepressants, and anticonvulsants. Initial studies were done in the late 1990s. In recent years, intravenous lipid emulsion therapy (ILE) has been frequently used in the intoxications of anesthetic and lipophilic drugs after animal experiments. We believe our report may contribute to the early use of ILE therapy for toxicity with calcium channel blockers such as verapamil in pediatric patients. She had resistant bradycardia and hypotension which was unresponsive to inotropic agents and a successful result was obtained after using ILE treatment. We used ILE therapy in a 14-year-old girl with verapamil intoxication in the 2 nd h of the pediatric intensive care unit stay, before using traditional treatments such as glucagon and hyperinsulinemic euglycemia. In the literature, there is a small number of reported cases about verapamil intoxication and ILE therapy in the pediatric age group. In recent years, intravenous lipid emulsion therapy (ILE) was used for lipophilic drug intoxications, and successful results were obtained. ![]() Keywords: Children, intoxication, lipid emulsion therapy, verapamil Abstract Merve Havan 1*, Tanıl Kendirli 1, Serhan Özcan 1, Melih Timuçin Doğan 2, Ahmet Onur Yiğit 1, Tayfun Uçar 2ġDepartment of Pediatric Intensive Care, School of Medicine, Ankara University, Ankara, TurkeyĢDepartment of Pediatric Cardiology, School of Medicine, Ankara University, Ankara, Turkey A successful treatment with intravenous lipid emulsion therapy in a child with verapamil poisoning ![]()
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