Chest
Volume 105, Issue 2, February 1994, Pages 606-607
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Selected Reports
Noncardiogenic Pulmonary Edema Complicating Massive Verapamil Overdose

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Noncardiogenic pulmonary edema has not been (to our knowledge) previously reported associated with a verapamil overdose. We describe a 27-year-old woman who developed this complication after an overdose of 15, 120-mg verapamil tablets (total of 1,800 mg). This report illustrates the possibility of serious pulmonary embarrassment in the course of a verapamil overdose and the need to avoid excessive crystalloid administration during the hypotensive period.

Section snippets

Case Report

A 27-year-old healthy woman was brought to the hospital 5 h after ingesting 15, 120-mg verapamil tablets (total of 1,800 mg Calan, G.D. Searle & Company, Chicago), 4 g of ibuprofen, and 10 tablets of a combination of acetaminophen, butalbital, and caffeine (Fioricet, Sandoz Pharmaceuticals Corporation, East Hanover, NJ). She was alert and oriented; the systolic BP was 70 mm Hg; pulse, 62 beats per minute; and respirations, 24 breaths per minute. The pupils were equal and responsive, and

Discussion

This patient demonstrates a case of noncardiogenic pulmonary edema after massive ingestion of verapamil. Noncardiogenic pulmonary edema was documented by bilateral diffuse pulmonary infiltrates on a chest radiograph with normal pulmonary capillary wedge pressure and thermodilution cardiac output. The signs and symptoms of noncardiogenic pulmonary edema resolved with conservative management and assisted ventilation for 72 h.

There appear to be several potential etiologies of this patient's

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