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Yusuke M, Hidetoshi Y, Yusuke T, Koji I, Masahito T, Susumu Y, Takayuki O. Intoxication with massive doses of amlodipine and candesartan requiring venoarterial extracorporeal membrane oxygenation. Acute Med Surg 2023; 10:e878. [PMID: 37533437 PMCID: PMC10392778 DOI: 10.1002/ams2.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023] Open
Abstract
Background Calcium channel blockers and angiotensin II receptor blockers are commonly prescribed to treat hypertension. Massive overdoses can cause both distributive and cardiogenic shock because of their effects on vascular smooth muscles and severe myocardial depression. Case Presentation We present the case of a 46-year-old man who was brought to our emergency department after ingesting 1210 mg amlodipine and 936 mg candesartan. The patient's hemodynamic status deteriorated despite treatment with vasopressors, calcium gluconate, and hyperinsulinemia-euglycemia therapy with mechanical ventilation. Venoarterial extracorporeal membrane oxygenation was initiated for refractory shock. The patient was weaned off extracorporeal membrane oxygenation on day 5 and discharged on day 18 of hospitalization. Conclusion When medical therapies are ineffective, aggressive venoarterial extracorporeal membrane oxygenation should be considered for the management of refractory shock in the setting of calcium channel blocker with angiotensin II receptor blocker overdose.
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Affiliation(s)
- Minagawa Yusuke
- Department of Emergency and Critical Care MedicineSaiseikai Utsunomiya HospitalUtsunomiyaJapan
| | - Yamana Hidetoshi
- Department of Emergency MedicineNational Hospital Organization Mito Medical CenterMitoJapan
| | - Tsutsumi Yusuke
- Department of Emergency MedicineNational Hospital Organization Mito Medical CenterMitoJapan
| | - Ishigami Koji
- Department of Emergency MedicineNational Hospital Organization Mito Medical CenterMitoJapan
| | - Togo Masahito
- Department of Emergency MedicineNational Hospital Organization Mito Medical CenterMitoJapan
| | - Yasuda Susumu
- Department of Emergency MedicineNational Hospital Organization Mito Medical CenterMitoJapan
| | - Ogura Takayuki
- Department of Emergency and Critical Care MedicineSaiseikai Utsunomiya HospitalUtsunomiyaJapan
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Lindeman E, Ålebring J, Johansson A, Ahlner J, Kugelberg FC, Nordmark Grass J. The unknown known: non-cardiogenic pulmonary edema in amlodipine poisoning, a cohort study. Clin Toxicol (Phila) 2020; 58:1042-1049. [PMID: 32114860 DOI: 10.1080/15563650.2020.1725034] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Context: Amlodipine is the most common calcium channel blocker (CCB) on the Swedish market, and poison center (PC) consultations for amlodipine overdoses are increasing. The clinical picture is dominated by vasodilation with relative preservation of cardiac function. CCBs selectively dilate vessels on the afferent side of the capillary network which, in states of preserved or increased blood flow may lead to edema formation, including non-cardiogenic pulmonary edema (NCPE). This complication has been considered rare in CCB poisoning. In this cohort study of nineteen amlodipine poisonings with high amlodipine blood levels, the incidence and clinical significance of NCPE in severe amlodipine poisoning are explored.Methods: During 2017-2018 the Swedish PC prospectively encouraged the gathering of blood samples in amlodipine poisonings with symptoms requiring treatment with inotropes or vasopressors. Samples were sent by mail to the Forensic Toxicology Division at the Swedish National Board of Forensic Medicine for screening and quantification of relevant toxicants. Patients with blood amlodipine levels >0.25 µg/mL were included in a cohort whose case details were gathered from medical records and PC-case notes with a special focus on signs of NCPE.Results: Nineteen patients met the blood amlodipine inclusion criteria. Four (21%) died and one patient was treated with VA-ECMO. Nine patients developed NCPE defined as a need for positive pressure ventilation (PPV) while having an echocardiographically normal left ventricular function.Conclusion: In this prospective cohort study of consecutive and analytically confirmed significant amlodipine poisonings NCPE was a common finding occurring in 47% of the whole cohort and in 64% of patients who did not go on to develop complete hemodynamic collapse.
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Affiliation(s)
- Erik Lindeman
- Swedish Poisons Information Center, Stockholm, Sweden
| | - Jonas Ålebring
- Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Anna Johansson
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Johan Ahlner
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.,Department of Medical and Health Sciences Division of Drug Research, Linköping University, Linköping, Sweden
| | - Fredrik C Kugelberg
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
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3
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Toxicological and Biochemical Analyses of an Autopsy Case Involving Oral Overdose of Multiple Antidiabetic and Antihypertensive Drugs. Case Rep Med 2018; 2018:5864658. [PMID: 30595699 PMCID: PMC6286784 DOI: 10.1155/2018/5864658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/05/2018] [Accepted: 11/04/2018] [Indexed: 11/17/2022] Open
Abstract
Oral antidiabetics can cause fatal hypoglycemia; although they can be chemically identified and quantified, biochemical investigations are important for assessing the biological consequences of an overdose. Such cases of overdose involving oral antidiabetics may involve other drugs for treating lifestyle-related diseases, particularly antihypertensives. Here, we report a toxicological and biochemical investigation of drugs and biochemical profiles in a fatal overdose involving multiple oral antidiabetics and antihypertensives. A 55-year-old woman died about 2 days after the ingestion of around 110 tablets of antidiabetics and antihypertensives that had been prescribed for her husband. A forensic autopsy and histological analysis demonstrated no evident pathology as the cause of death. A toxicological analysis suggested hypoglycemia and an overdose of antihypertensives as well as the retention of antidiabetics and diuretics in the pericardial fluid. A relatively low pericardial amlodipine concentration was observed, which may have been the result of its long half-life (slower distribution and reduction rate) and/or possible affinity with the myocardium. In addition, a biochemical analysis indicated hypoglycemia, without increased serum insulin and C-peptide, but with increased glucagon levels, as the possible influence of glibenclamide overdose. These observations suggest the usefulness of a combination of toxicological and biochemical analyses in postmortem investigations involving a fatal overdose of such drugs.
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Reuter-Rice KE, Peterson BM. Conventional and Unconventional Lifesaving Therapies in an Adolescent With Amlodipine Ingestion. Crit Care Nurse 2018; 36:64-9. [PMID: 27481803 DOI: 10.4037/ccn2016524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Amlodipine, a dihydropyridine calcium channel blocker, is commonly prescribed for the treatment of hypertension. Ingestion of an overdose leads to severe hypotension; if the hypotension is not treated, death may be imminent. Conventional and unconventional interventions were used to treat an adolescent who ingested a life-threatening dose of amlodipine. Severe hypotension resistant to conventional treatment with intralipids and hyperinsulinemia-euglycemia therapy led to the use of plasmapheresis and a pneumatic antishock garment as lifesaving measures. Plasmapheresis has been described in only one other case of severe amlodipine overdose, and the use of a pneumatic antishock garment has never been described in the management of a calcium channel blocker overdose. Because short-term use of a pneumatic antishock garment has associated risks, the critical care nurse's anticipation of side effects and promotion of safe use of the garment were instrumental in the patient's care and outcome. (Critical Care Nurse 2016; 36[4]:64-69).
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Affiliation(s)
- Karin E Reuter-Rice
- Karin E. Reuter-Rice is an associate professor and a Robert Wood Johnson Foundation scholar, School of Nursing and School of Medicine, Department of Pediatrics, Duke University, Durham, North Carolina. She is also a pediatric nurse practitioner in critical care at Duke University Health System and formerly at Rady Children's Hospital, San Diego, California.Bradley M. Peterson is a senior consultant to the pediatric intensive care unit, Rady Children's Hospital.
| | - Bradley M Peterson
- Karin E. Reuter-Rice is an associate professor and a Robert Wood Johnson Foundation scholar, School of Nursing and School of Medicine, Department of Pediatrics, Duke University, Durham, North Carolina. She is also a pediatric nurse practitioner in critical care at Duke University Health System and formerly at Rady Children's Hospital, San Diego, California.Bradley M. Peterson is a senior consultant to the pediatric intensive care unit, Rady Children's Hospital
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5
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Baker KA, Austin EB, Wang GS. Antidotes: Familiar Friends and New Approaches for the Treatment of Select Pediatric Toxicological Exposures. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2017. [DOI: 10.1016/j.cpem.2017.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Abstract
OBJECTIVE Overdoses with cardio-depressive medications can result in toxin-induced cardiogenic shock (TICS), a life-threatening condition characterized by severe hypotension and ineffective tissue perfusion. Vasopressors are often employed in the treatment of shock to increase heart rate and blood pressure. We sought to conduct a systematic review of the literature to evaluate the effectiveness of vasopressors in improving hemodynamic function and survival in the treatment of TICS. DATA SOURCES We searched PubMed, EMBASE, TOXLINE, and International Pharmaceutical Abstracts. STUDY SELECTION We included studies evaluating the use of vasopressors in humans or animals with TICS. We limited human study types to randomized controlled trials, clinical trials, observational studies, and case reports. DATA EXTRACTION Our search yielded 913 citations and 144 of these met our inclusion criteria. 130 were human case reports and 14 were animal studies. DATA SYNTHESIS Human case report data showed vasopressors were ineffective more often than they were partially or fully effective. In the majority of animal studies, vasopressor treatment failed to improve hemodynamic parameters and resulted in decreased survival. CONCLUSIONS Human case reports and controlled animal experiments lead to different conclusions about vasopressors in TICS. Most animal studies indicate that vasopressors impair hemodynamic function and increase mortality. In contrast, human case reports suggest that vasopressors are often ineffective but not necessarily harmful.
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Affiliation(s)
- Cassandra A Skoog
- a College of Pharmacy, University of Minnesota , Minneapolis , MN , USA
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7
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Décès toxique à l’amlodipine et l’olmésartan : à propos d’un cas avec pharmacobézoard. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2016. [DOI: 10.1016/j.toxac.2016.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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8
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Graudins A, Lee HM, Druda D. Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies. Br J Clin Pharmacol 2015; 81:453-61. [PMID: 26344579 DOI: 10.1111/bcp.12763] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/25/2015] [Accepted: 08/26/2015] [Indexed: 12/26/2022] Open
Abstract
Management of cardiovascular instability resulting from calcium channel antagonist (CCB) or beta-adrenergic receptor antagonist (BB) poisoning follows similar principles. Significant myocardial depression, bradycardia and hypotension result in both cases. CCBs can also produce vasodilatory shock. Additionally, CCBs, such as verapamil and diltiazem, are commonly ingested in sustained-release formulations. This can also be the case for some BBs. Peak toxicity can be delayed by several hours. Provision of early gastrointestinal decontamination with activated charcoal and whole-bowel irrigation might mitigate this. Treatment of shock requires a multimodal approach to inotropic therapy that can be guided by echocardiographic or invasive haemodynamic assessment of myocardial function. High-dose insulin euglycaemia is commonly recommended as a first-line treatment in these poisonings, to improve myocardial contractility, and should be instituted early when myocardial dysfunction is suspected. Catecholamine infusions are complementary to this therapy for both inotropic and chronotropic support. Catecholamine vasopressors and vasopressin are used in the treatment of vasodilatory shock. Optimizing serum calcium concentration can confer some benefit to improving myocardial function and vascular tone after CCB poisoning. High-dose glucagon infusions have provided moderate chronotropic and inotropic benefits in BB poisoning. Phosphodiesterase inhibitors and levosimendan have positive inotropic effects but also produce peripheral vasodilation, which can limit blood pressure improvement. In cases of severe cardiogenic shock and/or cardiac arrest post-poisoning, extracorporeal cardiac assist devices have resulted in successful recovery. Other treatments used in refractory hypotension include intravenous lipid emulsion for lipophilic CCB and BB poisoning and methylene blue for refractory vasodilatory shock.
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Affiliation(s)
- Andis Graudins
- Monash Health Clinical Toxicology and Addiction Medicine Service, Monash Health, Dandenong Hospital, David Street, Dandenong, VIC, 3175, Australia.,Monash Emergency Program, Monash Health, Dandenong Hospital, David Street, Dandenong, VIC, 3175, Australia.,School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Medical Centre, Clayton, VIC, 3168, Australia
| | - Hwee Min Lee
- Monash Health Clinical Toxicology and Addiction Medicine Service, Monash Health, Dandenong Hospital, David Street, Dandenong, VIC, 3175, Australia.,Monash Emergency Program, Monash Health, Dandenong Hospital, David Street, Dandenong, VIC, 3175, Australia.,School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Medical Centre, Clayton, VIC, 3168, Australia
| | - Dino Druda
- Monash Health Clinical Toxicology and Addiction Medicine Service, Monash Health, Dandenong Hospital, David Street, Dandenong, VIC, 3175, Australia.,Monash Emergency Program, Monash Health, Dandenong Hospital, David Street, Dandenong, VIC, 3175, Australia
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9
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Cibickova L, Caran T, Dobias M, Ondra P, Vorisek V, Cibicek N. Multi-drug intoxication fatality involving atorvastatin: A case report. Forensic Sci Int 2015; 257:e26-e31. [PMID: 26508377 DOI: 10.1016/j.forsciint.2015.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/24/2015] [Accepted: 09/30/2015] [Indexed: 11/13/2022]
Abstract
Mixed antihypertensive drug intoxication poses a significant risk for patient mortality. In tandem to antihypertensives, hypolipidemic medicines (especially statins) are often prescribed. Among their well-known adverse effects belongs rhabdomyolysis. We report a case of fatal multi-drug overdose in a 65-year-old female alcoholic. The patient was unconscious at admission. Empty blister packs indicated the abuse of 250 tablets of urapidil, 42 tablets of verapamil/trandolapril, 50 tablets of moxonidin, 80 tablets of atorvastatin and 80 tablets of diacerein. Standard measures (gastric lavage, activated charcoal, mechanical ventilation, massive doses of vasopressors, volume expansion, diuretics and alkalinization) failed to provide sufficient drug elimination and hemodynamic support and the sufferer deceased on the fourth day. Dramatic elevations of serum myoglobin (34,020 μg/L) and creatine kinase (219 μkat/L) were accompanied by rise in cardiac troponin I and creatinine. Gas chromatography revealed ethanol 1.17 g/kg (blood) and 2.81 g/kg (urine). Thin layer chromatography and gas chromatography of gastric content and urine verified verapamil, moxonidin and urapidil fragment (diacerein method was unavailable). Atorvastatin and trandolapril concentrations (LC-MS(n)) equaled 277.7 μg/L and 57.5 μg/L, resp. (serum) and 8.15 μg/L and 602.3 μg/L, resp. (urine). Histology confirmed precipitates of myoglobin with acute necrosis of proximal renal tubules in association with striated muscle rhabdomyolysis and myocardial dystrophy. Cardiogenic-distributive shock in conjunction with acute renal failure due to the combined self-poisoning with vasoactive agents and atorvastatin were determined to be this decedent's immediate cause of death. The manner of death was assigned to be suicidal.
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Affiliation(s)
- Lubica Cibickova
- 3(rd) Department of Internal Medicine-Nephrology, Rheumatology and Endocrinology, Palacky University Olomouc, Faculty of Medicine and Dentistry, Hněvotínská 3, 775 15 Olomouc, Czech Republic
| | - Tomas Caran
- Department of Anesthesiology and Resuscitation, Hospital Hranice, Zborovská 1245, 753 22 Hranice, Czech Republic
| | - Martin Dobias
- Department of Forensic Medicine and Medical Law, University Hospital Olomouc, Hněvotínská 3, 775 09 Olomouc, Czech Republic
| | - Peter Ondra
- Department of Forensic Medicine and Medical Law, University Hospital Olomouc, Hněvotínská 3, 775 09 Olomouc, Czech Republic
| | - Viktor Vorisek
- Institute of Clinical Biochemistry and Diagnostics, Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Norbert Cibicek
- Department of Medical Chemistry and Biochemistry, Palacky University Olomouc, Faculty of Medicine and Dentistry, Hněvotínská 3, 775 15 Olomouc, Czech Republic.
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10
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Noncardiogenic Pulmonary Edema after Amlodipine Overdose without Refractory Hypotension and Bradycardia. Case Rep Emerg Med 2015; 2015:546012. [PMID: 26075111 PMCID: PMC4436504 DOI: 10.1155/2015/546012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/15/2015] [Indexed: 11/25/2022] Open
Abstract
Amlodipine overdose can be life-threatening when manifesting as noncardiogenic pulmonary edema. Treatment remains challenging. We describe a case of noncardiogenic pulmonary edema without refractory hypotension and bradycardia after ingestion of 500 milligram amlodipine with suicidal intent. Mechanical ventilation, dexamethasone, atrovent HFA (ipratropium), pulmicort inhalation, and antibiotic therapy were used for the management. Length of hospital stay was 11 days. The patient was discharged with full recovery.
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11
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Lai F, Zhang Y, Xie DP, Li F, Han Y. Successful treatment with integrated Chinese and western medicine for severe overdose of amlodipine: A case report. Chin J Integr Med 2015; 21:703-6. [PMID: 25877462 DOI: 10.1007/s11655-015-2130-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Indexed: 10/23/2022]
Affiliation(s)
- Fang Lai
- Intensive Care Unit, Fangcun Branch Hospital, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510145, China
| | - Yan Zhang
- Intensive Care Unit, Fangcun Branch Hospital, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510145, China
| | - Dong-Ping Xie
- Intensive Care Unit, Fangcun Branch Hospital, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510145, China
| | - Fang Li
- Intensive Care Unit, Fangcun Branch Hospital, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510145, China
| | - Yun Han
- Intensive Care Unit, Fangcun Branch Hospital, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510145, China.
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Spiller HA, Milliner BA, Bosse GM. Amlodipine fatality in an infant with postmortem blood levels. J Med Toxicol 2012; 8:179-82. [PMID: 22271567 DOI: 10.1007/s13181-011-0207-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Amlodipine is a dihydropyridine calcium channel blocker used in the treatment of hypertension and angina pectoris. Toxic effects reported from amlodipine include hypotension, reflex tachycardia, metabolic acidosis, and pulmonary edema. We report a rare fatality in an infant after ingestion of amlodipine with benazepril, with postmortem blood concentrations. CASE REPORT An 11-month-old, 10.88-kg boy ingested 10 to 45 mg amlodipine with 40 to 180 mg benazepril. No action was taken initially because the parents believed only one or two capsules had been ingested. A later count revealed a maximum of nine capsules missing. The child was observed at home and vomited once with possible capsule fragments. Forty-five minutes post-ingestion, the child was noted to be suddenly unresponsive and was brought the local emergency department by a private vehicle. Upon arrival (90 min post-ingestion), the child was unresponsive with the following vital signs HR 133 bpm, BP 67/42 mmHg, respiratory rate 40/min, and temperature 97.5°F. Pertinent abnormal laboratory values were HCO(3) 13 mmol/l and glucose 302 mg/dl. The child was placed on oxygen via a non-rebreather mask and was intubated 45 min post-arrival. The patient became progressively bradycardic, and 55 min after arrival, the patient was in asystole with no palpable blood pressure. Resuscitation measures included chest compressions, epinephrine atropine, sodium bicarbonate, and calcium gluconate. Rescue insulin therapy was begun with 4 units IVP followed by 10 units per hour. Resuscitation efforts persisted for 1 h without success. An autopsy revealed pulmonary edema and no gross or microscopic evidence of natural disease. Stomach contents revealed food matter with small white fragments. Analysis of postmortem heart blood showed amlodipine 1,300 ng/ml (therapeutic <20 ng/ml). Benazepril levels were not available. DISCUSSION We believe this is the first reported fatality in an infant from amlodipine. While benazepril may have contributed, ACE inhibitors have not been previously associated with rapid cardiovascular collapse. CONCLUSION Small doses of amlodipine (0.9 to 4.1 mg/kg) may produce rapid and fatal cardiovascular collapse in an infant.
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Affiliation(s)
- Henry A Spiller
- Kentucky Regional Poison Control Center of Kosair Children's Hospital, Louisville, KY 40232-5070, USA.
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Hasson R, Mulcahy V, Tahir H. Amlodipine poisioning complicated with acute non-cardiogenic pulmonary oedema. BMJ Case Rep 2011; 2011:bcr.07.2011.4467. [PMID: 22679190 DOI: 10.1136/bcr.07.2011.4467] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Amlodipine poisoning is an uncommon presentation with potentially life threatening complications. As there are few cases of severe poisoning documented, management guidelines are limited. The authors present the case of a 22-year-old female who presented to hospital 6 h after ingesting 280 mg of amlodipine. She was treated with aggressive fluid resuscitation and calcium gluconate infusion. She went on to develop acute non-cardiogenic pulmonary odema for which she needed a frusemide infusion. She stayed in hospital for 5 days and was discharged after a psychiatric review with no long-term complications. The authors discuss the other management options available for patients presenting with amlodipine overdose.
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Affiliation(s)
- Ruairi Hasson
- Department of Acute Medicine, Whipps Cross Hospital, London, UK
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Holger JS, Stellpflug SJ, Cole JB, Harris CR, Engebretsen KM. High-dose insulin: A consecutive case series in toxin-induced cardiogenic shock. Clin Toxicol (Phila) 2011; 49:653-8. [DOI: 10.3109/15563650.2011.593522] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Engebretsen KM, Kaczmarek KM, Morgan J, Holger JS. High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning. Clin Toxicol (Phila) 2011; 49:277-83. [DOI: 10.3109/15563650.2011.582471] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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16
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Güvenç TS, Gürkan U, Güzelburç O, Ilhan E, Altay S. Barnidipine intoxication causing acute myocardial infarction. Am J Emerg Med 2010; 28:541.e1-3. [PMID: 20466265 DOI: 10.1016/j.ajem.2009.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Accepted: 08/17/2009] [Indexed: 11/18/2022] Open
Affiliation(s)
- Tolga Sinan Güvenç
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey.
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Smith SW, Ferguson KL, Hoffman RS, Nelson LS, Greller HA. Prolonged severe hypotension following combined amlodipine and valsartan ingestion. Clin Toxicol (Phila) 2009; 46:470-4. [DOI: 10.1080/15563650701779695] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Azendour H, Belyamani L, Atmani M, Balkhi H, Haimeur C. Severe amlodipine intoxication treated by hyperinsulinemia euglycemia therapy. J Emerg Med 2008; 38:33-5. [PMID: 18657931 DOI: 10.1016/j.jemermed.2007.11.077] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 11/01/2007] [Accepted: 11/09/2007] [Indexed: 11/25/2022]
Abstract
The objective of this study was to report a use of hyperinsulinemia euglycemia therapy in severe amlodipine intoxication. Intoxication with 420 mg of amlodipine caused severe hypotension in a 20-year-old female patient. The patient was initially treated with fluids, calcium gluconate, and epinephrine without effect. She was then given hyperinsulinemia euglycemia therapy. We observed a rise in blood pressure (BP) approximately 30 min after insulin was given and the BP was subsequently responsive to epinephrine. The patient was weaned from pressors 5 h after insulin therapy. The trachea was extubated 24 h after ingesting amlodipine, and the patient was transferred for psychiatric treatment 3 days later. This possible positive inotropic effect of insulin therapy in patients with calcium channel blocker intoxication supports previous findings. It is suggested that hyperinsulinemia euglycemia therapy may be considered as a first-line therapy in amlodipine intoxication.
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Affiliation(s)
- Hicham Azendour
- Medical Critical Care Unit, Military Hospital of Mohamed V, Rabat, Morocco
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