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Amlodipine fatality in an infant with postmortem blood levels
Henry A Spiller1, Beth A Milliner, George M Bosse
1Kentucky Regional Poison Control Center of Kosair Children's Hospital, Louisville, KY 40232-5070, USA. henry.spiller@nortonhealthcare.org
Summary
A rare case of infant fatality occurred after ingestion of amlodipine (a calcium channel blocker) and benazepril. Even small doses of amlodipine can cause rapid, fatal cardiovascular collapse in infants.
Area of Science:
- Toxicology
- Pediatric Emergency Medicine
- Cardiovascular Pharmacology
Background:
- Amlodipine, a dihydropyridine calcium channel blocker, is prescribed for hypertension and angina.
- Reported toxic effects include hypotension, reflex tachycardia, metabolic acidosis, and pulmonary edema.
- This case highlights a rare fatality in an infant due to amlodipine and benazepril ingestion.
Observation:
- An 11-month-old infant ingested a significant dose of amlodipine (0.9-4.1 mg/kg) and benazepril.
- The infant presented with unresponsiveness, hypotension, bradycardia, and metabolic acidosis.
- Despite aggressive resuscitation efforts including insulin therapy, the infant experienced asystole and could not be revived.
Findings:
- Postmortem blood analysis revealed a lethal concentration of amlodipine (1,300 ng/ml).
- Autopsy confirmed pulmonary edema, with no evidence of natural disease.
- This is the first reported infant fatality linked to amlodipine overdose.
Implications:
- This case underscores the potential for rapid and fatal cardiovascular collapse in infants following amlodipine overdose.
- Even small ingestions of amlodipine can be life-threatening in this age group.
- While benazepril's contribution is unclear, amlodipine appears to be the primary driver of the fatal outcome.
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