Multi-organ dysfunction as a presentation of calcium channel blocker intoxication.
Abdul-Fatawu Osman1, Rohan Madhu Prasad2, Shawn Marein3
1Michigan State University, East Lansing, Michigan, USA abdulfatawu01@gmail.com.
BMJ Case Reports
|January 18, 2022
Summary
A 73-year-old woman experienced severe hypotension and bradycardia after a 400 mg amlodipine overdose. Despite aggressive treatments including high-dose insulin therapy and intravenous lipid emulsion, she suffered multi-organ failure and death.
Area of Science:
- Cardiology
- Toxicology
- Critical Care Medicine
Background:
- Amlodipine overdose can lead to severe cardiovascular compromise.
- Management of refractory hypotension and bradycardia in overdose requires advanced critical care interventions.
Observation:
- A 73-year-old female presented with profound hypotension and bradycardia after ingesting 400 mg of amlodipine.
- Initial management included fluid resuscitation, vasopressors, high-dose insulin therapy, and calcium infusion, with limited effect.
- Salvage therapy with intravenous lipid emulsion (ILE) was administered.
Findings:
- Despite maximal therapeutic efforts, including high-dose insulin euglycaemic therapy (HIET) and ILE, the patient remained hemodynamically unstable.
- The patient progressed to multi-organ failure.
- The case highlights the limited efficacy of current advanced therapies in severe amlodipine toxicity.
Implications:
- This case underscores the potential for fatal outcomes even with aggressive critical care interventions in massive amlodipine overdose.
- Further research may be needed to explore novel therapeutic strategies for severe calcium channel blocker toxicity.
- Physicians should maintain a high index of suspicion for severe toxicity in patients presenting with refractory hypotension after calcium channel blocker ingestion.
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