Chest
Volume 99, Issue 1, January 1991, Pages 258-259
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Noncardiogenic Pulmonary Edema Complicating Massive Diltiazem Overdose

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Non-cardiogenic pulmonary edema has not been previously described in calcium channel blocker overdose. We describe a case of non-cardiogenic pulmonary edema occurring during the course of therapy for massive diltiazem overdose in a young patient with anorexia nervosa. Review of the current literature suggests that major and minor pulmonary complications occur with some frequency in the setting of calcium channel blocker overdose although their exact incidence remains unclear. (Chest 1991; 99:258–60)

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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.

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