Toxicology

Answer: C

The best treatment option for this patient is whole bowel

irrigation because of the extended-release formulation

of diltiazem (Answer C is correct). Activated char-

coal may provide some benefit, but, similar to ipecac,

the time interval is not known, and diltiazem does

not undergo enterohepatic recirculation (Answer A is

incorrect). Ipecac is not recommended because it may

impede treatment with more effective treatment options

and because it is no longer manufactured in the United

States (Answer B is incorrect). A cathartic would not be

useful in this situation; guidelines recommend its use

only in combination with other decontamination strate-

gies, not as a single agent (Answer D is incorrect).

Answer: A

There are several potential antidotes for a calcium chan-

nel blocker overdose. Calcium is the most effective, and

it should be given by bolus, followed by continuous infu-

sion if needed (Answer A is correct). Glucagon is not an

effective antidote and is therefore not an option for this

patient (Answer B is incorrect). Atropine is effective for

symptomatic bradycardia caused by the calcium chan-

nel blocker, but the dose should be 0.5–1 mg (Answer C

is incorrect). Epinephrine is an alternative to glucagon,

but this dose is excessive for a patient not experiencing

cardiac arrest (Answer D is incorrect).

Answer: D

Most of the SSRIs are relatively safe, and many patients

will present as asymptomatic after an overdose.

However, there is a potential for a patient to develop

serious adverse effects, such as serotonin syndrome,

seizures, and cardiac toxicity. Although this patient is

stable and has no specific concerns, it is recommended

to check a 12-lead ECG to measure for QT-interval

prolongation and treat with sodium bicarbonate, if nec-

essary (Answer D is correct). A benzodiazepine should

be administered if muscle rigidity develops, but it

should not be used as a prophylactic measure (Answer

A is incorrect). It is recommended that the patient be

observed for at least 6–8 hours. Cyproheptadine is

only indicated for symptomatic patients (Answer B is

incorrect). Measures should be performed to reduce

hyperthermia if a serotonergic syndrome develops, but

this should be treated with measures to reduce muscle

activity (i.e., sedation or chemical paralysis), not by

applying measures to enhance surface cooling (Answer

C is incorrect).

Although the patient appears to have taken an overdose of

olanzapine, she is experiencing only mild symptoms. The

best intervention would be to monitor her for 6 hours for

the progression of her symptoms or development of addi-

tional complications (Answer D is correct). Intravenous

fluids would be appropriate if the patient has dehydration

or hypotension (Answer A is incorrect). Sodium bicarbon-

ate is indicated for QRS prolongation and is not warranted

at this time (Answer B is incorrect). Olanzapine does not

cause seizures; therefore, lorazepam would not be indi-

cated (Answer C is incorrect).

The most appropriate intervention at this time is to give

the patient intravenous dextrose (Answer B is correct).

Oral glucose is a viable option, but it cannot be admin-

istered to an unconscious patient without oral access

(Answer A is incorrect). Octreotide should be reserved

for use if the administration of a glucose solution fails

to raise the blood glucose above 70 mg/dL for two con-

secutive readings (Answer C is incorrect). Glucagon is

a potential option for treatment, but because the patient

has intravenous access, the intramuscular route would

not be preferred (Answer D is incorrect).