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.
Written by Dr David Harding
First published 19 January 2023