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Near fatal case of amlodipine poisoning in an infant

Somashekhar M Nimbalkar1, Dipen Vasudev Patel

  • 1Department of Pediatrics, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, District, Anand, Gujarat 388325, India. somu_somu@yahoo.com

Indian Journal of Pediatrics
|July 26, 2012
PubMed

Insights

Amlodipine overdose in an infant caused severe shock, but rapid improvement occurred with insulin and dextrose therapy. This highlights hyperglycemia as a key indicator in calcium channel blocker poisoning.

Area of Science:

  • Pediatric Toxicology
  • Cardiovascular Pharmacology
  • Emergency Medicine

Background:

  • Medication errors can lead to severe toxicity, even with commonly prescribed drugs.
  • Calcium channel blockers (CCBs) like amlodipine can cause significant adverse effects when overdosed.
  • Understanding the metabolic consequences of CCB overdose is crucial for effective treatment.

Observation:

  • An 11-month-old infant accidentally received 12.5 times the maximum dose of amlodipine.
  • The infant presented with vomiting, lethargy, breathlessness, and hypotensive shock within 3 hours.
  • Initial supportive care including mechanical ventilation, fluids, and inotropes was insufficient.

Findings:

  • Rapid improvement was observed only after initiating insulin and dextrose infusion, along with glucagon and calcium gluconate.
  • Calcium channel blockers impair insulin secretion, leading to hyperglycemia, which appears to be a more significant prognostic indicator than hemodynamic variables in poisoning.
  • Successful management of amlodipine poisoning was achieved with continuous insulin infusion (0.5-1 U/kg/h) and supportive care, including peritoneal dialysis for renal dysfunction.

Implications:

  • Hyperglycemia management is a critical therapeutic target in calcium channel blocker poisoning.
  • Insulin infusion therapy should be considered as a primary treatment modality for severe CCB overdose.
  • This case underscores the importance of vigilant medication error monitoring and prompt, targeted interventions in pediatric toxicology.

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