Citation

Matsushime S, Kuriyama A. Ann. Med. Surg. (Lond.) 2021; 65.

Copyright

(Copyright © 2021, Surgical Associates, Publisher Elsevier Publishing)

DOI

10.1016/j.amsu.2021.102292

PMID

unavailable

Abstract

BACKGROUND: While there are consensus recommendations for managing calcium channel blocker (CCB) toxicity, reports on angiotensin II receptor blocker (ARB) toxicity and management are limited. Herein, we report a case of catecholamine-refractory hypotension due to CCB and ARB overdose. Case presentation: A 54-year-old woman with underlying hypertension was brought to the emergency department after she attempted suicide by ingesting 345 mg of amlodipine, a CCB, and 340 mg of olmesartan, an ARB. She was hypotensive, which was considered vasodilatory because of high cardiac and low systemic vascular resistance indices. Hypotension persisted despite the administration of norepinephrine and epinephrine. Intravenous calcium gluconate, glucagon, and high-dose insulin euglycemia therapy, which were initiated because CCB toxicity was suspected, failed to raise her blood pressure. The presence of normal anion-gap metabolic acidosis and the fact that the patient remained hypotensive suggested that the hypotension might have been due to the effect of ARB. Vasopressin was finally administered, which improved her hemodynamic status. She was weaned off all vasopressors on day 3.

DISCUSSION: There is no consensus recommendation for ARB toxicity. Since chronic use of ARBs at conventional doses can block the sympathetic nervous and renin-angiotensin systems, catecholamines may not effectively increase blood pressure in cases of hypotension due to ARB overdose, for which vasopressin could be indicated.

CONCLUSIONS: Vasopressin could be an option for treating hypotension secondary to ARB and CCB toxicity when catecholamines and treatment for CCB toxicity fail. © 2021

Language: en

Keywords

adult; human; mental health; suicide; female; case report; insomnia; suicide attempt; drug overdose; retrospective study; clinical article; physical examination; middle aged; noradrenalin; emergency ward; follow up; hemodynamics; hypotension; computer assisted tomography; drug toxicity; hypertension; glucose blood level; heart rate; glucose; bicarbonate; insulin; creatinine; creatinine blood level; calcium channel blocking agent; gluconate calcium; metabolic acidosis; glucagon; Drug overdose; etizolam; laboratory test; blood pressure; insulin treatment; lactate blood level; catecholamine; vasopressin; Article; crystalloid; arterial gas; angiotensin receptor antagonist; heart left ventricle ejection fraction; transthoracic echocardiography; olmesartan; amlodipine; Vasopressins; pulse rate; breathing rate; hypertensive factor; brotizolam; mean arterial pressure; lactic acid; bicarbonate blood level; diagnostic test accuracy study; vasoplegia; epinephrine; blood carbon dioxide tension; Angiotensin receptor antagonists; systemic vascular resistance; vasodilatory shock