TY  - JOUR
PY  - 2013//
TI  - Prolonged refractory hypotension secondary to amlodipine overdose: A therapeutic challenge
JO  - ICU director
A1  - Kambali, S.
A1  - Alalawi, R.
A1  - Nugent, K.
SP  - 136
EP  - 142
VL  - 4
IS  - 3
N2  - 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).<p /> <p>Language: en</p>
LA  - en
SN  - 1944-4524
UR  - http://dx.doi.org/10.1177/1944451613481383
ID  - ref1
ER  -