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Saeed A, Naghshzan A. Successful treatment of severe calcium channel blocker poisoning, new experience with the guidance of invasive hemodynamic monitoring in a 17-year-old girl: a case report. J Med Case Rep 2024; 18:68. [PMID: 38308385 PMCID: PMC10837995 DOI: 10.1186/s13256-024-04345-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/29/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Calcium channel blocker poisoning is one of the most lethal cardiac drugs overdoses. Calcium and high-dose insulin infusion are the first-line therapy for symptomatic patients, and Intralipid emulsion infusion is useful for refractory cases. CASE PRESENTATION In this report, we describe a 17-year-old Iranian girl who took 250 mg of the drug for a suicidal attempt and presented with refractory hypotension and non-cardiogenic pulmonary edema treated successfully with the guidance of invasive hemodynamic parameters. CONCLUSION For complicated cases, in addition to supportive care and adjuvant therapy such as high-dose insulin and Intralipid, it is mandatory to utilize advanced hemodynamic monitoring to treat hypotension in severe calcium channel blocker poisoning to guide the treatment.
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Affiliation(s)
- Amir Saeed
- Scientific Association of Intensive Care and ICU of Iran, Tehran, Iran
| | - Amir Naghshzan
- Cardiovascular and Neonatology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Gautam S, Chamlagain M, Yadav GK, Acharya S. Once was not enough: A case report of the concomitant intoxication of amlodipine (calcium channel blocker) and clonazepam (benzodiazepine). Clin Case Rep 2022; 10:e6042. [PMID: 35846941 PMCID: PMC9272439 DOI: 10.1002/ccr3.6042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/09/2022] [Accepted: 06/26/2022] [Indexed: 11/23/2022] Open
Abstract
We report a case of concurrent ingestion of Clonazepam and Amlodipine in a 25‐year‐old man, in a second attempt to take his life, which resulted in unconsciousness, hypotension, and hypokalemia. The clinical and/or biochemical presentation varied from the individual pattern when ingested. In the scarcity of consensus recommendations, supportive treatment helped. Supportive treatment is the rule of management of concomitant ingestion of Amlodipine and Clonazepam. The clinical and/or biochemical presentation of benzodiazepine and calcium channel blocker may vary from the individual pattern.
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Affiliation(s)
- Swotantra Gautam
- Department of Critical Care Medicine Nidan Hospital Lalitpur Nepal
| | | | - Gopal Kumar Yadav
- Department of Emergency Medicine Kakani Primary Health Care Centre Nuwakot Nepal
| | - Santosh Acharya
- Department of Anesthesiology and Critical Care Nidan Hospital Lalitpur Nepal
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Jang HW, Park SM, Hwang SY, Kang K, Choi M, An JH, Chae HK, Oh YI, Youn HY. Unusual case of pleural effusion caused by amlodipine in a dog with systemic hypertension. Vet Med Sci 2022; 8:445-449. [PMID: 35132803 PMCID: PMC8959262 DOI: 10.1002/vms3.727] [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] [Indexed: 11/19/2022] Open
Abstract
Objective The aim of this report is to document the case of a dog that developed pleural effusion as a potential side‐effect to the administration of a high‐dose of amlodipine. Case summary A Yorkshire terrier dog (13‐year‐old, castrated male, 4.5 kg) presented with severe systemic hypertension (>200 mmHg), hyperkalaemia, and acute pancreatitis. The dog had hyperadrenocorticism, chronic valvular heart disease, chronic kidney disease, and cerebellar infarction as underlying diseases. Additionally, the dog had laboured breathing and tachypnoea during hospitalization. Screening examinations revealed a pleural effusion (pure transudate) for which hypoalbuminemia and thromboembolism were ruled out as the causes. Therefore, the adverse drug event of an anti‐hypertensive drug (amlodipine) was tentatively diagnosed. Conclusions Pleural effusion resolved within 24 h of reducing the dosage of amlodipine. Hence, the dog was diagnosed with amlodipine‐induced pleural effusion. Rarely, amlodipine can cause pleural effusion after high‐dose administrations in humans, but only two cases of peripheral edema have been reported in animals. If pleural effusion occurs in hypertensive patients administered amlodipine, it should be considered as the potential cause.
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Affiliation(s)
- Hee-Won Jang
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Su-Min Park
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Seo-Young Hwang
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Kyuyong Kang
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Mincheol Choi
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Ju-Hyun An
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hyung-Kyu Chae
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Ye-In Oh
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hwa-Young Youn
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
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Howells PA, Aldridge KA, Parekh D, Park D, Tucker O, Dancer RCA, Gao F, Perkins GD, Thickett DR. ARDS following oesophagectomy: a comparison of two trials. BMJ Open Respir Res 2017; 4:e000207. [PMID: 29435341 PMCID: PMC5687524 DOI: 10.1136/bmjresp-2017-000207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/10/2017] [Accepted: 10/04/2017] [Indexed: 01/08/2023] Open
Abstract
Introduction The Beta Agonist Lung Injury Trial-Prevention (BALTI-P) translational substudy and Vitamin D to Prevent Acute Lung Injury Following Oesophagectomy (VINDALOO) trials recruited patients undergoing oesophagectomy, 4 years apart. The acute respiratory distress syndrome (ARDS) rates were lower in the VINDALOO trial. We sought to identify changes between these two trials and identify risk factors for ARDS in oesophagectomy. Methods There were data available from 61 patients in the BALTI-P substudy and 68 from VINDALOO. Databases were available for both trials; additional data were collected. Multivariate logistic regression was used to analyse risk factors for ARDS and postoperative complications in the cohorts combined. Results Logistic regression analysis showed active smoking was associated with an increase in ARDS (OR 3.91; 95% CI 1.33 to 11.5) and dihydropyridine use (OR 5.34;95% CI 1.56 to 18.3). Hospital length of stay was longer for those who took dihydropyridines (median 29 days (IQR 17–42) vs 13 days (IQR 10–18), P=0.0007) or were diabetic (median 25 days (IQR 14–39) vs 13 (IQR 10–19), P=0.023) but not for current smokers (median in never/ex-smokers 13 (IQR 10–23) vs current smokers 15 (IQR 11–20), P=0.73). Conclusions Smoking cessation trials should be promoted. Dihydropyridine effects perioperatively require further clinical and mechanistic evaluation. Patients undergoing oesophagectomy are a useful model for studying perioperative ARDS.
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Affiliation(s)
- Phillip A Howells
- Peri-operative and critical care trials group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Kerrie A Aldridge
- Peri-operative and critical care trials group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Department of Respiratory Medicine, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Dhruv Parekh
- Peri-operative and critical care trials group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Department of Respiratory Medicine, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Daniel Park
- Department of Critical Care Medicine, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Olga Tucker
- Department of Upper Gastrointestinal Surgery, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Rachel C A Dancer
- Peri-operative and critical care trials group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Department of Respiratory Medicine, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Fang Gao
- Peri-operative and critical care trials group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Department of Critical Care Medicine, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Gavin D Perkins
- Department of Critical Care Medicine, Heart of England NHS Foundation Trust, Birmingham, UK.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Birmingham, UK
| | - David R Thickett
- Peri-operative and critical care trials group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Department of Respiratory Medicine, University Hospitals Birmingham NHS Trust, Birmingham, UK
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