Liquid Chromatography–High-Resolution Mass Spectrometry (LC–HRMS) Analysis Following Voluntary Carvedilol Poisoning in a Subject with Cirrhosis: A Case Report

Abstract

Abstract Accidental or intentional carvedilol poisoning is rarely reported. Here, we describe a case of attempted suicide with a large quantity of immediate-release carvedilol (75 mg) and alcohol. In order to determine the kinetics, liquid chromatography–high-resolution mass spectrometry analyses were performed. The results for the plasma concentration of carvedilol were 906 µg/L 3 h after ingestion, 288 µg/L 12 h after ingestion and 103 µg/L 24 h after ingestion. A one-compartment model with linear and first order best described the elimination of the carvedilol, and the estimated half-life was 5.8 h. The result 3 h after ingestion represented the highest concentration ever observed for this drug. However, the patient was cirrhotic, and liver function was impaired with decreased Factor V (45%) and prothrombin ratio (61%). These conditions may explain the high concentrations of carvedilol. The patient was treated with glucagon and discharged from the hospital the following day.