{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T10:26:50Z","timestamp":1782728810389,"version":"3.54.5"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2011,8,20]],"date-time":"2011-08-20T00:00:00Z","timestamp":1313798400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2011,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Introduction<\/jats:title>\n            <jats:p>Massive intentional verapamil overdose is a toxic ingestion which can cause multiorgan system failure and has no currently known antidote.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Case Presentation<\/jats:title>\n            <jats:p>The patient is a 41-year-old Caucasian woman who ingested 19.2 g of sustained release verapamil in a suicide attempt. Our patient became hypotensive requiring three high-dose vasopressors to maintain arterial pressure. She also developed acute respiratory failure, bradycardic ventricular rhythm necessitating continuous transvenous pacing, and anuric renal failure. Our patient was treated with intravenous calcium, bicarbonate, hyperinsulinemic euglycemic therapy and continuous venovenous hemodialysis without success. On the fourth day after hospital admission continuous intravenous lipid therapy was initiated. Within three hours of beginning lipid therapy, our patient's vasopressor requirement decreased by half. Within 24 hours, she was on minimal vasopressor support and regained an underlying junctional rhythm. After three days of lipid infusion, she no longer required inotropic agents to maintain blood pressure or pacing to maintain stable hemodynamics.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Intravenous fat emulsion therapy may be an effective antidote for massive verapamil toxicity.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1752-1947-5-399","type":"journal-article","created":{"date-parts":[[2011,8,20]],"date-time":"2011-08-20T06:15:46Z","timestamp":1313820946000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Lipid rescue of massive verapamil overdose: a case report"],"prefix":"10.1186","volume":"5","author":[{"given":"Conrad W","family":"Liang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah J","family":"Diamond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S","family":"Hagg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2011,8,20]]},"reference":[{"key":"1748_CR1","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/S0196-0644(05)80202-1","volume":"22","author":"EA Ramoska","year":"1993","unstructured":"Ramoska EA, Spiller HA, Winter M, Borys D: A one-year evaluation of calcium channel blocker overdoses: toxicity and treatment. Ann Emerg Med. 1993, 22: 196-200. 10.1016\/S0196-0644(05)80202-1.","journal-title":"Ann Emerg Med"},{"key":"1748_CR2","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1055\/s-2002-20585","volume":"23","author":"CR Newton","year":"2002","unstructured":"Newton CR, Delgado JH, Gomez HF: Calcium and beta receptor antagonist overdose: a review and update of pharmacological principles and management. Semin Respir Crit Care Med. 2002, 23: 19-25. 10.1055\/s-2002-20585.","journal-title":"Semin Respir Crit Care Med"},{"key":"1748_CR3","doi-asserted-by":"publisher","first-page":"2794","DOI":"10.1097\/01.CCM.0000100123.50896.F0","volume":"31","author":"JL Zimmerman","year":"2003","unstructured":"Zimmerman JL: Poisonings and overdoses in the intensive care unit: general and specific management issues. Crit Care Med. 2003, 31: 2794-2801. 10.1097\/01.CCM.0000100123.50896.F0.","journal-title":"Crit Care Med"},{"key":"1748_CR4","doi-asserted-by":"publisher","first-page":"223","DOI":"10.2165\/00139709-200423040-00003","volume":"23","author":"CR DeWitt","year":"2004","unstructured":"DeWitt CR, Waksman JC: Pharmacology, pathophysiology and management of calcium channel blocker and beta-blocker toxicity. Toxicol Rev. 2004, 23: 223-238. 10.2165\/00139709-200423040-00003.","journal-title":"Toxicol Rev"},{"key":"1748_CR5","doi-asserted-by":"publisher","first-page":"19","DOI":"10.2165\/00003495-198938010-00003","volume":"38","author":"D McTavish","year":"1989","unstructured":"McTavish D, Sorkin EM: Verapamil. An updated review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension. Drugs. 1989, 38: 19-76. 10.2165\/00003495-198938010-00003.","journal-title":"Drugs"},{"key":"1748_CR6","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1080\/15563650802559632","volume":"46","author":"AC Bronstein","year":"2008","unstructured":"Bronstein AC, Spyker DA, Cantilena LR, Green JL, Rumack BH, Heard SE: 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). 2008, 46: 927-1057. 10.1080\/15563650802559632.","journal-title":"Clin Toxicol (Phila)"},{"key":"1748_CR7","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1016\/0002-9343(93)90314-F","volume":"95","author":"CA Hofer","year":"1993","unstructured":"Hofer CA, Smith JK, Tenholder MF: Verapamil intoxication: a literature review of overdoses and discussion of therapeutic options. Am J Med. 1993, 95: 431-438. 10.1016\/0002-9343(93)90314-F.","journal-title":"Am J Med"},{"key":"1748_CR8","first-page":"258","volume":"310","author":"M Ashraf","year":"1995","unstructured":"Ashraf M, Chaudhary K, Nelson J, Thompson W: Massive overdose of sustained-release verapamil: a case report and review of literature. Am J Med Sci. 1995, 310: 258-263.","journal-title":"Am J Med Sci"},{"key":"1748_CR9","first-page":"4074","volume":"169","author":"KK Johansen","year":"2007","unstructured":"Johansen KK, Belhage B: [A 48-year-old woman's survival from a massive verapamil overdose]. Ugeskr Laeger. 2007, 169: 4074-4075.","journal-title":"Ugeskr Laeger"},{"key":"1748_CR10","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1007\/BF03160947","volume":"4","author":"MT Sim","year":"2008","unstructured":"Sim MT, Stevenson FT: A fatal case of iatrogenic hypercalcemia after calcium channel blocker overdose. J Med Toxicol. 2008, 4: 25-29. 10.1007\/BF03160947.","journal-title":"J Med Toxicol"},{"key":"1748_CR11","doi-asserted-by":"crossref","first-page":"350","DOI":"10.5694\/j.1326-5377.2009.tb02822.x","volume":"191","author":"CP Nickson","year":"2009","unstructured":"Nickson CP, Little M: Early use of high-dose insulin euglycaemic therapy for verapamil toxicity. Med J Aust. 2009, 191: 350-352.","journal-title":"Med J Aust"},{"key":"1748_CR12","doi-asserted-by":"crossref","first-page":"520","DOI":"10.4037\/ajcc2007.16.5.520","volume":"16","author":"NP Patel","year":"2007","unstructured":"Patel NP, Pugh ME, Goldberg S, Eiger G: Hyperinsulinemic euglycemia therapy for verapamil poisoning: case report. Am J Crit Care. 2007, 16: 520-518-519","journal-title":"Am J Crit Care"},{"key":"1748_CR13","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1053\/j.jvca.2007.01.009","volume":"21","author":"LB Verbrugge","year":"2007","unstructured":"Verbrugge LB, van Wezel HB: Pathophysiology of verapamil overdose: new insights in the role of insulin. J Cardiothorac Vasc Anesth. 2007, 21: 406-409. 10.1053\/j.jvca.2007.01.009.","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"1748_CR14","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1111\/j.1553-2712.2006.tb01661.x","volume":"13","author":"S Tebbutt","year":"2006","unstructured":"Tebbutt S, Harvey M, Nicholson T, Cave G: Intralipid prolongs survival in a rat model of verapamil toxicity. Acad Emerg Med. 2006, 13: 134-139. 10.1111\/j.1553-2712.2006.tb01661.x.","journal-title":"Acad Emerg Med"},{"key":"1748_CR15","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1111\/j.1553-2712.2008.00259.x","volume":"15","author":"E Perez","year":"2008","unstructured":"Perez E, Bania TC, Medlej K, Chu J: Determining the optimal dose of intravenous fat emulsion for the treatment of severe verapamil toxicity in a rodent model. Acad Emerg Med. 2008, 15: 1284-1289. 10.1111\/j.1553-2712.2008.00259.x.","journal-title":"Acad Emerg Med"},{"key":"1748_CR16","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1111\/j.1553-2712.2009.00499.x","volume":"16","author":"G Cave","year":"2009","unstructured":"Cave G, Harvey M: Intravenous lipid emulsion as antidote beyond local anesthetic toxicity: a systematic review. Acad Emerg Med. 2009, 16: 815-824. 10.1111\/j.1553-2712.2009.00499.x.","journal-title":"Acad Emerg Med"},{"key":"1748_CR17","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1097\/00000542-199804000-00028","volume":"88","author":"GL Weinberg","year":"1998","unstructured":"Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ: Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology. 1998, 88: 1071-1075. 10.1097\/00000542-199804000-00028.","journal-title":"Anesthesiology"},{"key":"1748_CR18","doi-asserted-by":"publisher","first-page":"139","DOI":"10.2165\/00139709-200625030-00001","volume":"25","author":"G Weinberg","year":"2006","unstructured":"Weinberg G: Lipid rescue resuscitation from local anaesthetic cardiac toxicity. Toxicol Rev. 2006, 25: 139-145. 10.2165\/00139709-200625030-00001.","journal-title":"Toxicol Rev"},{"key":"1748_CR19","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1097\/00000542-200607000-00033","volume":"105","author":"MA Rosenblatt","year":"2006","unstructured":"Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB: Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology. 2006, 105: 217-218. 10.1097\/00000542-200607000-00033.","journal-title":"Anesthesiology"},{"key":"1748_CR20","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1111\/j.1365-2044.2006.04740.x","volume":"61","author":"RJ Litz","year":"2006","unstructured":"Litz RJ, Popp M, Stehr SN, Koch T: Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion. Anaesthesia. 2006, 61: 800-801. 10.1111\/j.1365-2044.2006.04740.x.","journal-title":"Anaesthesia"},{"key":"1748_CR21","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1016\/j.annemergmed.2007.06.004","volume":"51","author":"AJ Sirianni","year":"2008","unstructured":"Sirianni AJ, Osterhoudt KC, Calello DP, Muller AA, Waterhouse MR, Goodkin MB, Weinberg GL, Henretig FM: Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine. Ann Emerg Med. 2008, 51: 412-415. 10.1016\/j.annemergmed.2007.06.004.","journal-title":"Ann Emerg Med"},{"key":"1748_CR22","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1097\/CCM.0b013e31819b5261","volume":"37","author":"J Brent","year":"2009","unstructured":"Brent J: Poisoned patients are different-sometimes fat is a good thing. Crit Care Med. 2009, 37: 1157-1158. 10.1097\/CCM.0b013e31819b5261.","journal-title":"Crit Care Med"},{"key":"1748_CR23","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1111\/j.1365-2044.2008.05830.x","volume":"64","author":"J Picard","year":"2009","unstructured":"Picard J, Harrop-Griffiths W: Lipid emulsion to treat drug overdose: past, present and future. Anaesthesia. 2009, 64: 119-121. 10.1111\/j.1365-2044.2008.05830.x.","journal-title":"Anaesthesia"},{"key":"1748_CR24","doi-asserted-by":"publisher","first-page":"2325","DOI":"10.1097\/CCM.0b013e3181aabcd7","volume":"37","author":"G Cave","year":"2009","unstructured":"Cave G, Harvey M: Lipid emulsion as antidotal therapy-ready to register?. Crit Care Med. 2009, 37: 2325-2326.","journal-title":"Crit Care Med"},{"key":"1748_CR25","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1111\/j.1553-2712.2007.tb01752.x","volume":"14","author":"TC Bania","year":"2007","unstructured":"Bania TC, Chu J, Perez E, Su M, Hahn IH: Hemodynamic effects of intravenous fat emulsion in an animal model of severe verapamil toxicity resuscitated with atropine, calcium, and saline. Acad Emerg Med. 2007, 14: 105-111. 10.1111\/j.1553-2712.2007.tb01752.x.","journal-title":"Acad Emerg Med"},{"key":"1748_CR26","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1016\/j.resuscitation.2009.01.023","volume":"80","author":"AC Young","year":"2009","unstructured":"Young AC, Velez LI, Kleinschmidt KC: Intravenous fat emulsion therapy for intentional sustained-release verapamil overdose. Resuscitation. 2009, 80: 591-593. 10.1016\/j.resuscitation.2009.01.023.","journal-title":"Resuscitation"},{"key":"1748_CR27","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1097\/MEJ.0b013e32834130ab","volume":"18","author":"V Montiel","year":"2011","unstructured":"Montiel V, Gougnard T, Hantson P: Diltiazem poisoning treated with hyperinsulinemic euglycemia therapy and intravenous lipid emulsion. Eur J Emerg Med. 2011, 18: 121-123. 10.1097\/MEJ.0b013e32834130ab.","journal-title":"Eur J Emerg Med"},{"key":"1748_CR28","doi-asserted-by":"publisher","first-page":"340","DOI":"10.3109\/15563650.2011.572556","volume":"49","author":"D French","year":"2011","unstructured":"French D, Armenian P, Ruan W, Wong A, Drasner K, Olson KR, Wu AH: Serum verapamil concentrations before and after Intralipid\u00ae therapy during treatment of an overdose. Clin Toxicol (Phila). 2011, 49: 340-344. 10.3109\/15563650.2011.572556.","journal-title":"Clin Toxicol (Phila)"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1752-1947-5-399.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/1752-1947-5-399\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1752-1947-5-399","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1752-1947-5-399.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T15:40:12Z","timestamp":1630510812000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/1752-1947-5-399"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,8,20]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2011,12]]}},"alternative-id":["1748"],"URL":"https:\/\/doi.org\/10.1186\/1752-1947-5-399","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,8,20]]},"assertion":[{"value":"9 January 2011","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 August 2011","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 August 2011","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"399"}}