LETTER
Colonic Ischemia after Verapamil Overdose
Heriberto Gutierrez, MD, and
Michael Jorgensen, MD
1 March 1996 | Volume 124 Issue 5 | Page 535
TO THE EDITOR:
The most frequent manifestations of verapamil overdose are conduction disturbances and hypotension [1], both of which can lead to ischemia. The right colon is susceptible to ischemia because of the variable amount of collateral blood flow present [2]. We report a case of colonic ischemia after verapamil overdose.
A 54-year-old woman with a history of bipolar disorder and alcoholism was being treated for hypertension with verapamil (80 mg twice daily). She came to the emergency department intoxicated after taking approximately 20 verapamil tablets as a suicide attempt. Her blood pressure was 73/30 mm Hg, and her pulse rate was 75 beats/min. She was somnolent and had thready peripheral pulses. An electrocardiogram showed an accelerated junctional rhythm. Gastric lavage yielded pill particles. Despite administration of intravenous fluids, calcium gluconate, and vasopressors, the patient's blood pressure only marginally improved. She subsequently developed lower abdominal pain. Repeated examination showed abdominal distension with lower-quadrant guarding and absent bowel sounds. Her leukocyte count was 27 000 cells/mm3, and radiographs of the abdomen showed nonspecific dilation of the cecum. An exploratory laparotomy showed a gangrenous segment of the cecum and terminal ileum; the rest of the large and small bowel was normal. She had an uncomplicated right hemicolectomy and was hemodynamically stable during the remainder of her hospitalization.
Stroke has been previously associated with verapamil overdose presumably because of hypotension-induced cerebral ischemia [3]. Long-term verapamil use has also been reported as a cause of stercoral perforation of the sigmoid colon [4]. We are aware of no previous report of bowel ischemia caused by verapamil overdose. The development of abdominal pain seen in our patient warrants thorough evaluation because of the risk for ischemia or infarction of the intestinal tract.
Heriberto Gutierrez, MD
Michael Jorgensen, MD
Kaiser Permanente Medical Center
Los Angeles, CA 90027
|
Author and Article Information
|
|---|
Kaiser Permanente Medical Center Los Angeles, CA 90027
1. Hofer CA, Smith JK, Tenholder MF. Verapamil intoxication: a literature review of overdoses and discussion of therapeutic options. Am J Med. 1993; 95:431-38.
2. Landreneau RJ, Fry WJ. The right colon as a target organ of nonocclusive mesenteric ischemia. Arch Surg. 1990; 125:591-4.
3. Shah AR, Passalacqua BR. Case report. Sustained-release verapamil overdose causing stroke: an unusual complication. Am J Med Sci. 1992; 304:357-9.
4. Doughthy JC, Donald AK, Keogh G, Cooke TG. Stercoral perforation with verapamil. Postgrad Med. J. 1994; 70:525.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Top
Author & Article Info
References
Article
