Severe Amlodipine Toxicity: A Case Rescued with Extracorporeal Membrane Oxygenation

Area of Science:

• Cardiology
• Clinical Toxicology
• Critical Care Medicine

Background:

• Amlodipine is a common antihypertensive medication.
• Amlodipine toxicity can lead to severe myocardial depression and refractory hypotension.
• Massive overdoses are rare but pose significant clinical challenges.

Purpose of the Study:

• To report a rare case of massive amlodipine overdose.
• To highlight the successful use of extracorporeal membrane oxygenation (ECMO) in managing severe amlodipine toxicity.
• To emphasize ECMO as a potential rescue therapy for refractory hypotension in overdose cases.

Main Methods:

• A 28-year-old female with seizure disorder and depression presented after consuming 400 mg of amlodipine.
• Management in the Intensive Care Unit (ICU) included mechanical ventilation and vasopressor support.
• Venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated due to refractory hypotension.

Main Results:

• The patient presented 23 hours post-ingestion with severe symptoms.
• Despite intensive medical management, refractory hypotension persisted.
• Initiation of VA-ECMO led to successful stabilization and recovery.

Conclusions:

• Massive amlodipine overdose can cause life-threatening hypotension.
• VA-ECMO can be an effective rescue therapy for severe amlodipine-induced cardiovascular collapse.
• Prompt recognition and aggressive management, including mechanical circulatory support, are crucial for survival.