Hemoadsorption Therapy for Calcium Channel Blocker Overdose: A Case Report.

Area of Science:

• Toxicology
• Nephrology
• Critical Care Medicine

Background:

• Calcium channel blocker (CCB) overdose presents a significant challenge due to their pharmacokinetic properties, often rendering standard extracorporeal removal methods ineffective.
• While ex vivo models suggest styrene bead adsorption can eliminate CCBs, clinical data on modern resin hemoadsorption/hemoperfusion for CCB overdose is scarce.

Observation:

• A young male patient presented with refractory shock following a significant overdose of amlodipine and risperidone.
• Despite intensive supportive care, including fluids, calcium, catecholamines, and hyperinsulinemic-euglycemic therapy, hemodynamic instability persisted.
• Methylene blue was administered, but weaning from vasopressors remained unsuccessful.

Findings:

• Hemoperfusion utilizing a styrene resin filter (Jafron HA230) was initiated in two 6-hour sessions, 18 hours apart.
• Following hemoperfusion, the patient successfully weaned off all circulatory support, with normalization of lactate levels and subsequent discharge.
• High amlodipine concentrations detected in blood from the filter post-session strongly suggested enhanced drug clearance.

Implications:

• This case suggests resin hemoperfusion may be a viable therapeutic option for severe, refractory calcium channel blocker overdose, potentially improving outcomes.
• The rapid resolution of shock post-hemoperfusion, occurring within less than one amlodipine elimination half-life, supports the efficacy of this intervention.
• Emergency physicians should consider hemoperfusion as a salvage therapy in cases of CCB overdose unresponsive to conventional treatments.