A 27 year old lady presents to the Emergency Department having taken an unknown quantity of her father’s diltiazem following a family argument.
On arrival she is drowsy, pale and cold peripherally. Her BP is 64/40 mmHg, HR 60 bpm and a venous blood gas shows a metabolic acidosis with lactate of 4 mmol/L. The Emergency Department have administered 2 litres of intravenous crystalloid with minimal effect on her observations.
She is intubated and ventilated before being transferred to the Intensive Care Unit for further management.
