Abstract
We report a case of a 61-year-old woman treated for a suspected verapamil overdose with continuous calcium chloride infusion, resulting in severe hypercalcemia of 32.3 mg/dL (8.07 mmol/L) with a normal range of 8.6–10.5 mg/dL (2.15–2.63 mmol/L). Treatment with acute hemodialysis rapidly normalized the serum calcium level, but the patient later died of vasoconstrictive complications of hypercalcemia.
Keywords: hypercalcemia, verapamil, calcium channel blocker toxicity, dialysis
Full Text
The Full Text of this article is available as a PDF (113.0 KB).
Footnotes
There was no outside funding of any kind used for this study.
References
- 1.Orrell DH. Albumin as an aid to the interpretation of serum calcium. Clin Chim Acta. 1971;35(2):483–489. doi: 10.1016/0009-8981(71)90224-5. [DOI] [PubMed] [Google Scholar]
- 2.Shepherd G. Treatment of poisoning caused by β-adrenergic and calcium channel blockers. Am J Health-Syst Pharm. 2006;63:1828–1835. doi: 10.2146/ajhp060041. [DOI] [PubMed] [Google Scholar]
- 3.Kerns W, Kline J, Ford MD. Beta-blocker and calcium channel blocker toxicity. Emerg Med Clin North Am. 1994;12(2):365–390. [PubMed] [Google Scholar]
- 4.Oe H, Taniura T, Ohgitani N. A case of severe verapamil overdose. Jpn Circ J. 1998;62:72–76. doi: 10.1253/jcj.62.72. [DOI] [PubMed] [Google Scholar]
- 5.Ramoska EA, Spiller HA, Winter M, et al. A one-year evaluation of calcium channel blocker overdoses: toxicity and treatment. Ann Emer Med. 1993;22(2):196–200. doi: 10.1016/S0196-0644(05)80202-1. [DOI] [PubMed] [Google Scholar]
- 6.Buckley NA, Dawson AH, Howarth DM. Slow release verapamil poisoning. Use of polyethylene glycol whole bowel lavage and high-dose calcium. Med J Aust. 1993;6:408–430. [PubMed] [Google Scholar]
- 7.Kline J, Leonova E, Raymond RM. Beneficial myocardial effects of insulin during verapamil toxicity in the anesthetized canine. Crit Care Med. 1995;23(7):1251–1263. doi: 10.1097/00003246-199507000-00016. [DOI] [PubMed] [Google Scholar]
- 8.Hariman RJ, Mangiardi LM, McAllister RG, et al. Reversal of the cardiovascular effects of verapamil by calcium and sodium: differences between electrophysiologic and hemodynamic responses. Circ. 1979;59(4):797–804. doi: 10.1161/01.cir.59.4.797. [DOI] [PubMed] [Google Scholar]
- 9.Kenny J. Treating overdose with calcium channel blockers. BMJ. 1994;308(6935):992–993. doi: 10.1136/bmj.308.6935.992. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Pearigen PD, Benowitz NL. Poisoning due to calcium antagonists. Experience with verapamil, diltiazem and nifedipine. Drug Saf. 1991;6(6):408–430. doi: 10.2165/00002018-199106060-00003. [DOI] [PubMed] [Google Scholar]
- 11.Chan AK, Duh QY, Katz MH, Siperstein AE, Clark OH. Clinical manifestations of primary hyperparathyroidism before and after parathyroidectomy. A case-control study. Ann Surg. 1995;222(3):402–412. doi: 10.1097/00000658-199509000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Hung Y, Olson KR. Acute amlodipine overdose treated by high dose intravenous calcium in a patient with severe renal insufficiency. Clin Tox. 2007;45:301–303. doi: 10.1080/15563650601072233. [DOI] [PubMed] [Google Scholar]
- 13.Lam Y, Tse H, Lau C. Continuous calcium chloride infusion for massive nifedipine overdose. Chest. 2001;119:1280–1282. doi: 10.1378/chest.119.4.1280. [DOI] [PubMed] [Google Scholar]
- 14.Isbister GK. Delayed asystolic cardiac arrest after diltiazem overdose: resuscitation with high dose intravenous calcium. Emerg Med J. 2002;19:355–357. doi: 10.1136/emj.19.4.355. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Brenner BM, Levy E, Hostetter TH. Tubulointerstitial diseases of the kidney. In: Fauci AS, editor. Harrison’s Principles of Internal Medicine. 14th ed. New York: McGraw-Hill; 1998. pp. 276–80. [Google Scholar]
- 16.Pargger H, Kaufmann MA, Drop LJ. Renal vascular hyper-responsiveness to elevated ionized calcium in spontaneously hypertensive rat kidneys. Intensive Care Med. 1998;24(1):61–70.. doi: 10.1007/s001340050516. [DOI] [PubMed] [Google Scholar]
- 17.Castelli I, Steiner LA, Kaufmann MA, Drop LJ. Renovascular responses to high and low perfusate calcium steady-state experiments in the isolated perfused rat kidney with baseline vascular tone. J Surg Res. 1996;61(1):51–57. doi: 10.1006/jsre.1996.0080. [DOI] [PubMed] [Google Scholar]
- 18.Kover G, Tost H. Effects of hypercalcemia on kidney function in anesthetized dogs. Acta Physiol Hung. 1993;81(4):971–993. [PubMed] [Google Scholar]
- 19.Adrogue HJ, Frazier MR, Zeluff B, et al. Systemic calciphy-laxis revisited. Am J Nephrol. 1981;1(3–4):177–183. doi: 10.1159/000166536. [DOI] [PubMed] [Google Scholar]
- 20.Essary LR, Wick MR. Cutaneous calciphylaxis. An under-recognized clinicopathologic entity. Am J Clin Pathol. 2000;113(2):280–287. doi: 10.1309/AGLF-X21H-Y37W-50KL. [DOI] [PubMed] [Google Scholar]
- 21.Koo WS, Jeon DS, Ahn SJ, et al. Calcium-free hemodialysis for the management of hypercalcemia. Nephron. 1996;72(3):424–428. doi: 10.1159/000188907. [DOI] [PubMed] [Google Scholar]
- 22.Shigematsu T, Kawaguchi Y, Kubo H, et al. Low calcium (1.25 mmol/L) dialysate can normalize relative hypoparathy-roidism in CAPD patients with low bone turnover. Adv Perit Dial. 1996;12:250–256. [PubMed] [Google Scholar]
- 23.Schulman G, Himmelfarb J. In: Hemodialysis. Brenner and Rector’s The Kidney. 7th ed. Brenner BM, editor. Philadelphia: Saunders Co.; 2004. pp. 2578–2588. [Google Scholar]
- 24.Sigrist M, McIntyre CW. Calcium exposure and removal in chronic hemodialysis patients. J Ren Nutr. 2006;16(1):41–46. doi: 10.1053/j.jrn.2005.10.006. [DOI] [PubMed] [Google Scholar]
- 25.Strong HE, Schatz BC, Shinaberger JH, et al. Measurement of dialysance and bi-directional fluxes of calcium in vivo using radiocalcium. Trans ASAIO. 1971;17:108–115. [PubMed] [Google Scholar]
- 26.Don BR, Chin AI. A strategy for the treatment of calcific uremic arteriolopathy (calciphylaxis) employing a combination of therapies. Clin Nephrol. 2003;59(6):463–470. doi: 10.5414/cnp59463. [DOI] [PubMed] [Google Scholar]