Ranolazine overdose
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Various toxicities following an overdose of ranolazine in a suicide attempt: case report A 67-year-old man developed emesis, acute altered mental status with confusion, first-degree atrioventricular block, convulsive episodes, pulseless electrical activity, ventricular tachycardia and asystole following an overdose of ranolazine in a suicide attempt. The man had hypertension, coronary artery disease, chronic angina and schizophrenia. His home medications included atorvastatin, clonazepam and clopidogrel. He presented to the emergency department with a complaint of emesis. He had ingested approximately 30g of extended-release ranolazine several hours prior in a suicide attempt. Upon physical examination, he was found to be alert with no acute distress. Vitals signs revealed the following: BP 160/87mm Hg, HR 72 beats/min, RR 18 breaths/minute and pulse oximetry 99% room air. An ECG showed normal sinus rhythm (73 beats/minute), corrected QT interval (QTc) 434ms and QRS 96ms. Laboratory analysis showed normal electrolytes, renal and hepatic function. Paracetamol [acetaminophen], ethanol and salicylate concentrations were undetectable. Seven hours after presentation, he developed acute altered mental status with confusion. The ECG showed a first-degree atrioventricular block at 66 beats/minute, PR interval 220ms, QRS 108ms and QTC 450ms. Nine hours after presentation, three convulsive episodes occurred, each lasting several minutes, before spontaneously resolving. Shortly thereafter, he developed pulseless electrical activity for 20 minutes, followed by ventricular tachycardia and ultimately asystole. The man received defibrillation, continuous cardiopulmonary resuscitation and advanced cardiac life support, but resuscitation was unsuccessful. An ante-mortem serum ranolazine concentration was above the therapeutic range at 12 mg/L. Furlano ER, et al. Anti-anginal asystole: Fatal ranolazine overdose. Clinical Toxicology 58: 630, No. 6, 2020. Available from: URL: http:// doi.org/10.1080/15563650.2020.1741981 [abstract]
0114-9954/20/1823-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
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Reactions 26 Sep 2020 No. 1823
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