Citation

Kambali S, Alalawi R, Nugent K. ICU Dir. 2013; 4(3): 136-142.

Copyright

(Copyright © 2013)

DOI

10.1177/1944451613481383

PMID

unavailable

Abstract

Calcium channel blocker overdose is one of the leading causes of overdose death among cardiovascular medications. We present a patient with the highest reported dose of amlodipine ingestion in combination pill. She was asymptomatic initially and soon became hypotensive and obtunded. She was intubated for airway protection, gastric lavage was done, and activated charcoal was given. She was resuscitated with 4L 0.9% normal saline, calcium chloride, glucagon, insulin, and glucose infusions. Her hypotension worsened necessitating use of norepinephrine 200 μg/min, phenylephrine 200 μg/min, dopamine 50 μg/kg/min, and vasopressin 0.06 U/min concurrently. She continued to improve and was weaned off vasopressors and mechanical ventilation. Few cases of extremely highdose ingestion have been reported. Patients may be normotensive but rapidly progress to shock depending on ingested dose. High doses are associated with shock, bradycardia, pulmonary edema, renal failure, and heart failure. The primary goal is to maintain adequate circulation. Therapy includes intravenous fl uids, insulin, glucagon, vasopressors, calcium infusion, and atropine. Based on our patient and a review of literature, we conclude that patients with near-fatal calcium channel blocker ingestion usually have good outcomes with appropriate use of highdose vasopressors, glucagon, and insulin. © 2013 The Author(s).

Language: en

Keywords

adult; human; suicide; female; resuscitation; case report; drug overdose; article; drug intoxication; priority journal; stomach lavage; noradrenalin; dopamine; activated carbon; hypotension; drug megadose; glucose blood level; glucose; dose response; insulin; glucagon; sorbitol; calcium; vasopressin; calcium blood level; drug dose increase; outcome assessment; calcium chloride; phenylephrine; acute respiratory failure; hypertensive factor; mean arterial pressure; assisted ventilation; amlodipine plus hydrochlorothiazide plus olmesartan; Calcium channel blocker overdose; Hypotension management