Abstract
A 30-year-old woman and a 37-year-old man were admitted to the emergency department because of shock and altered consciousness of unknown cause. They complained of general fatigue and presented with a symptom similar to hypotension. Both patients showed severe bradycardia, atrioventricular block, acute renal failure with oliguria and increased serum creatinine, and poor response to catecholamines. The next day, many empty press-through packages of medicine, including diltiazem and nicorandil, were found in the patients' room. They were primarily diagnosed with calcium channel blocker poisoning due to an overdose of diltiazem. The patients failed to respond to treatment with intravenous calcium gluconate. However, they showed a significant response to treatment with calcium chloride, which led to an immediate increase in blood pressure and the recovery of sinus rhythm. The patients resumed the general conditions and were discharged without any complaints. Later, high concentration of diltiazem, desacetyl-diltiazem, and nicorandil were detected in their serum samples. Some reports recommend the use of calcium chloride rather than calcium gluconate for the treatment of calcium channel blocker poisoning. Therefore, the present findings suggest that intravenous administration of calcium chloride is an alternative treatment for patients who do not respond to calcium gluconate.
