A 62-year-old female with a history of schizophrenia was found unresponsive after ingesting supratherapeutic amounts of diltiazem and valsartan. At presentation to the emergency department, she was hypotensive and bradycardic. Eight hours later, a blood sample (Fig. 1A) was drawn for chemistry analysis and ultracentrifuged to clarify the turbidity (Fig. 1B). However, the lab was unable to assay the plasma sample. Multiple samples yielded similar findings. Plasma samples obtained the following day were appropriate for analysis. 

Questions

  1. What interfering substances are causing the plasma's strawberry milk appearance?
  2. What off-label medication was administered to this patient?
  3. What drug(s) may be responsible for causing the abnormal appearance of her plasma?

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