A 31-year-old female had attempted suicide with 56 diltiazem 30 mg immediate-release (IR) tablets of her father’s prescription and was admitted into emergency department after one hour of ingestion. First vital signs revealed temperature of 36.2℃, blood pressure of 58/27 mmHg and pulse of 71 beats/min. The electrocardiogram showed junctional bradycardia. She was given the following treatment:
GI  decontamination (activated charcoal, AC 61.5g), antidotes (calcium gluconate 10%  10mL and glucagon 3mg) and supportive care (atropine 1mg, dopamine 800mg, norepinephrine 8mg and normal saline 500mL). After 12 hours of emergency treatment, her blood pressure and heart rate returned to normal (114/70 mmHg and 88 beats/min). Finally, she was subsequently transferred to the intensive care unit for further observation and treatment, and then discharged after 4 days of admission. In calcium channel blockers (CCBs) intoxication, hypotension and bradycardia are the most important clinical features and non- dihydropyridine classes have much effect in suppression cardiac contractility. In this case, copious medication was used to treat 1) hypotension and 2) bradycardia respectively: 1) calcium gluconate, dopamine, norepinephrine and insulin; 2) calcium gluconate, glucagon and atropine. This case successfully treated suicidal diltiazem overdose, and showed that in the management of CCB overdose, attention must  be  paid  to  severe  fetal  side  effects of  hypotension and  bradycardia using various medications with the purpose of maintaining the vital signs.

本案例報告一位 31 歲女性因服用 56 顆速效型 diltiazem  30mg 自殺，於一小時後送至 急診室，入院時體溫 36.2℃、血壓 58/27 mmHg，而脈搏為每分鐘 71 下，心電圖顯示有房 室結性心搏徐緩。醫矚上立即給予活性碳 61.5g、拮抗劑（calcium gluconate 10% 10mL 和 glucagon 3mg）支持療法（atropine 1mg、dopamine 800mg、norepinephrine 8mg 和 normal saline 500mL）治療，經 12 小時緊急處置後，患者的血壓及心跳恢復正常，經轉送至加護病房繼 續觀察，於治療  4 天後出院。低血壓及心搏徐緩是鈣離子阻斷劑過量最重要的臨床表徵之 一，non-dihydropyridine（像  diltiazem 與 verapamil）對心肌有很強的收縮抑制效果。本案 急救過程中使用很多藥物來治療包含：(1)治療低血壓用藥：calcium gluconate、dopamine、 norepinephrine 和胰島素；(2)降低心搏徐緩症狀：calcium gluconate、glucagon 和 atropine。 本案例提供成功治療服用過量 diltiazem 的自殺案件，處理過程中顯示處理鈣離子阻斷劑過 量患者須注意其低血壓及心搏徐緩的現象，並利用各種不同藥物來維持其生命表徵。