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Published:
Journal of Analytical Toxicology,
ISSN 0146-4760,
Volume 26, Number 6, September 2002,
pp. 374-377
CASE REPORT: Lethal Diltiazem Poisoning
Guido Romano, Nunziata Barbera, Carlo Rossitto, and Giorgio
Spadaro
Dipartimento di Anatomia, Patologia Diagnostica, Medicina Legale, Igiene e Sanità
Pubblica, Università di Catania,
Via S. Sofia 87 – Comparto 10 - 95123 Catania, Italia
A 60-year-old man presented
to an emergency department 2 h after the ingestion of 8 g of diltiazem (about
40 slow-release capsules, 200 mg/each) in a suicide attempt. The subject was
treated with a gastric lavage and activated charcoal; then, a temporary transvenous
pacing was also inserted. Despite emergency pharmacological treatment, the subject
died about 20 h after ingestion. Postmortem diltiazem and desacetyl-diltiazem
concentrations, measured by gas chromatography–mass spectrometry, were
as follows: 31.1 mg/mL diltiazem and 9.7 mg/mL desacetyl-diltiazem in blood;
33.1 mg/g diltiazem and 13.7 mg/g desacetyl-diltiazem in brain; 179.5 mg/g diltiazem
and 47.5 mg/g desacetyl-diltiazem in lung; 41.8 mg/g diltiazem and 10.1 mg/g
desacetyl-diltiazem in heart; 182.1 mg/g diltiazem and 47.3 mg/g desacetyl-diltiazem
in liver; 49.2 mg/g diltiazem and 22.6 mg/g desacetyl-diltiazem in kidney; and
294.9 mg/mL diltiazem and 29.4 mg/mL desacetyl-diltiazem in bile. It is interesting
to note that although several cases of acute diltiazem poisoning have been reported
in literature, only a few were lethal. Diltiazem concentrations found in our
case are notably higher than those reported in other studies, including those
in which diltiazem ingestion resulted in the death of the patient. Notably,
in many of these latter cases, the doses of diltiazem ingested were higher than
those taken by our patient. Reproduction
of editorial content of this journal is prohibited without publisher’s
permission.
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