Periportal edema after cardiac arrest due to calcium channel blocker overdose

Abstract

A 41-year-old man with a history of diabetes mellitus and hypertension presented to our emergency department with changes in consciousness. The patient’s vital signs included a heart rate of 22 beats/min with presence of weak carotid pulses, respiration of 8 breaths/min, and a core temperature 33.8 C. On examination, the patient had a Glasgow coma score of 3, and was cold and clammy. Initial resuscitation included tracheal intubation, supplementary oxygen, 1 mg intravenous atropine, and starting a dopamine infusion. Pulseless electrical activity cardiac arrest occurred soon after arrival. Circulation was restored after 2 minutes of cardiopulmonary resuscitation and one bolus dose of 1 mg intravenous adrenaline. A 12-lead electrocardiogram revealed sinus rhythm. Cardiac enzyme analysis result was within normal limits. The patient’s blood pressure remained low, requiring aggressive fluid resuscitation and high-dose inotropes. Fifteen minutes after return of spontaneous circulation, abdominal computed tomography was ordered to evaluate the possibility of intra-abdominal sepsis, which demonstrated hypodense areas around portal veins of both lobes of the liver, compatible with periportal edema (Fig. 1), dilated inferior vena cava, minimal ascites, and