FATAL DILTIAZEM OVERDOSE - REPORT OF 4 CASES AND REVIEW OF THE LITERATURE

Four fatal cases of diltiazem overdose are described and compared with previously published cases. Clinical sequelae include all grades of h eart block, hypotension and ultimately death. Management includes gast ric lavage and oral administration of activated charcoal at presentati on. Further symptomatic treatment with inotropic agents and temporary cardiac pacing may be required. If these measures are successful, reco very occurs within 36 hours in uncomplicated cases. Toxicological data have been reviewed but currently drug levels can only offer a retrosp ective analysis of the severity of overdoses. As the use and risk of a buse of diltiazem increases, these reports serve to highlight the poss ible hazards and to alert physicians to what must be regarded as a dan gerous and potentially lethal drug in overdosage.