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Prolonged profound hypotension complicating severe methyldopa overdose.

Thomas Y K Chan, Gavin M Joynt

International Journal of Clinical Pharmacology and Therapeutics

|April 24, 2014

Summary

Severe methyldopa overdose is rare but can cause prolonged hypotension. Management requires intensive monitoring and fluid and vasopressor therapy to stabilize blood pressure.

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Area of Science:

Pharmacology
Clinical Toxicology

Background:

Methyldopa is a long-established centrally acting antihypertensive medication.
Severe overdose cases are infrequently reported in medical literature.

Observation:

A 50-year-old female ingested over 75g of methyldopa, presenting with severe hypotension (BP 59/27 mmHg) and bradycardia (HR 49 bpm).
The patient required intensive care unit admission for management of profound hypotension and drowsiness.

Findings:

Treatment involved extensive fluid resuscitation, colloids (Gelofusine), and prolonged vasopressor support (norepinephrine and dopamine) for over 60 hours.
Hemodynamic stability was achieved with sustained systolic blood pressure around 100 mmHg.

Implications:

This case highlights that severe methyldopa overdose can lead to prolonged and profound hypotension.
Effective management necessitates vigilant monitoring of vital signs and aggressive use of intravenous fluids, colloids, and vasopressors.