Chest
Noncardiogenic Pulmonary Edema Complicating Massive Diltiazem Overdose
Section snippets
CASE REPORT
A 30-year-old nurse was hospitalized after having been found apathetic and unable to ambulate. She was known to be taking diltiazem for migraine headaches and had a long history of stress disorder and depression and had previously been evaluated for anorexia nervosa.
On examination, she was lethargic but responsive to noxious stimuli. The blood pressure varied from 58/32 mm Hg to 90/60 mm Hg and the pulse from 35 to 45 per minute. The respiratory rate was 18. She had warm skin and full pulses
DISCUSSION
We present a clearcut case of noncardiogenic pulmonary edema occurring in association with a massive ingestion of diltiazem. We can only speculate as to the relative effects of the drug itself and of the patient's rather prolonged shock-like state on the genesis of the pulmonary edema. Hypotension of similar severity and duration has been reported after verapamil overdose without development of overt pulmonary edema.1 The pulmonary artery pressure values and normal cardiac index exclude
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Supported in part by the Marshall University Foundation. Presented in part at the 1989 Scientific Meeting, Pennsylvania and West Virginia Regions, American College of Physicians, Pittsburgh, October 6, 1989.