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[Lethal polypharmacy in a patient with arterial hypertension]
1Departement Pharmazie & Pharmakologie, Slotervaart Ziekenhuis/holländisches Krebszentrum, Amsterdam, Niederlande. apmsj@slz.nl
Deutsche Medizinische Wochenschrift (1946)
|December 14, 2004
Summary
A case report highlights severe hyperkalemia and bradycardic arrhythmia in an elderly patient, likely linked to hydrochlorothiazide, amiloride, timolol, verapamil, and trandolapril. This led to hypotension, coma, and ultimately death.
Area of Science:
- Cardiology
- Pharmacology
- Nephrology
Background:
- An 86-year-old male presented with ventricular escape rhythm and severe hypotension.
- The patient was on long-term hydrochlorothiazide, amiloride, and timolol, with recent addition of verapamil and trandolapril for hypertension.
Observation:
- Admission revealed coma, lactic acidosis, and severe hyperkalemia.
- Neurological deterioration necessitated intubation and mechanical ventilation.
- Brain CT showed infarction in the left middle cerebral artery territory with edema.
Findings:
- Hyperkalemia was treated successfully with calcium gluconate, insulin, and glucose.
- External cardiac pacing and epinephrine support were discontinued after achieving sinus rhythm.
- Despite treatment, renal failure persisted, and the patient died on day six.
Implications:
- This case suggests a probable drug-associated severe hyperkalemia and bradycardic arrhythmia.
- The event underscores the potential for adverse drug reactions in elderly patients with multiple comorbidities.
- Careful medication review is crucial to prevent potentially fatal drug interactions and side effects.
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