University of Wisconsin–Madison Medical College of Wisconsin

Use of Intravenous Lipid Emulsion Therapy and Insulin in a Case of Tarka Intoxication

Emrah Gün, MD; Mahmut Çiçek, MD; Mustafa Kafalı, MD; Hüsnü Demir, MD; İlknur Arslan, MD; Tanıl Kendirli, MD

WMJ. 2024;123(2):144-146

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Introduction: Tarka (trandolapril/verapamil hydrohloride extended-release) is a fixed-dose combination antihypertensive drug formed from verapamil hydrochloride and trandolapril. Toxicologic manifestations of Tarka overdose are altered mental status, bradycardia, hypotension, atrioventricular block (first-degree), hyperglycemia, metabolic acidosis, and shock.

Case Presentation: We report a case of Tarka toxicity in a 2-year-old girl who presented with altered mental status, cardiogenic shock, hypotension, bradycardia, severe metabolic acidosis, hyperglycemia, and first-degree atrioventricular block. We started fluid resuscitation, epinephrine, norepinephrine, and insulin. Because of the patient’s hyperlactatemia and hypotension despite standard therapies, we initiated intravenous lipid emulsion (ILE) therapy, after which her condition improved promptly.

Discussion: Tarka overdose may be life-threatening as it can cause cardiogenic shock. In our patient, the regression of lactate elevation in a short time with ILE therapy and the improvement of her general condition highlight the importance of ILE.

Conclusions: ILE is an alternative treatment method for acute lipophilic drug intoxications, such as Tarka.

Author Affiliations: Department of Pediatric Intensive Care, Adana City Hospital, Adana, Turkey (Gün, Arslan); Department of Pediatrics, Adana City Hospital, Adana, Turkey (Çiçek, Kafah); Department of Pediatric Cardiology, Adana City Hospital, Adana, Turkey (Demir); Department of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey (Kendirli).
Corresponding Author: Emrah Gün, MD, Department of Pediatric Intensive Care, Adana City Hospital, Adana, Turkey; email; ORCID ID 0000-0001-7337-0190
Funding/Support: None declared.
Financial Disclosures: None declared.
Acknowledgments: Approval for publication of this case report was obtained from the Institutional Review Board and the family of the patient.
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