What to do with case reports: is folly that succeeds folly nonetheless?

Case files of the medical toxicology fellowship of the California poison control system-San Francisco: calcium plus digoxin-more taboo than toxic?

A 68 year old woman with a history of diabetes mellitus presented to the emergency department after experiencing several days of nausea and vomiting. Recorded vital signs included: blood pressure 98/32 mm Hg, heart rate 69 bpm, "normal" respirations, and no fever. Her initial ECG revealed peaked T waves and regular rhythm with no visible P waves. Initial serum electrolytes were notable for a potassium level of 7.7 mmol/L, and a creatinine level of 9.6 mg/dL (849 micromol/L). She was unable to provide a list of her current medications or other medical history. There was no old chart immediately available for comparison.

Metaraminol (Aramine) in the management of a significant amlodipine overdose

OBJECTIVE

To report a patient with a significant amlodipine self-poisoning who failed to clinically respond to conventional treatment and was managed with metaraminol (Aramine).

PATIENT

A 43-year old male presenting after ingestion of 560 mg amlodipine, who failed to respond clinically to treatment with fluid resuscitation, calcium salts, glucagon and norepinephrine/epinephrine inotropic support.

MAIN RESULTS

Following a loading bolus of 2 mg and intravenous infusion (83 microg/min) of metaraminol (Aramine) there was improvement in his blood pressure, cardiac output and urine output.

CONCLUSIONS

This is the first case report of the beneficial use of metaraminol (aramine) in the management of significant amlodipine poisoning unresponsive to conventional therapy.