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A Case of Angiotensin II Utilization for Refractory Shock in a Polysubstance Overdose
Brian W Gilbert1, Charles S Wilson2, Nicholas Kim3
1Department of Pharmacy, Emergency Medicine, Wesley Medical Center, 550 N. Hillside Street, Wichita, KS, 67214, USA. Brian.gilbert.pharmd@gmail.com.
Summary
In severe amlodipine and quetiapine overdoses causing refractory shock, angiotensin II (Ang II) administration was effective. This case suggests Ang II may be a crucial salvage therapy for complex polysubstance ingestions when standard treatments fail.
Area of Science:
- Cardiology
- Pharmacology
- Toxicology
Background:
- Amlodipine and quetiapine are common medications with generally good safety profiles.
- Overdoses can cause severe, life-threatening cardiovascular compromise, including refractory vasoplegia.
- Managing poly-ingestion overdoses is complex, often necessitating aggressive, multimodal interventions.
Purpose of the Study:
- To report a case of refractory shock due to amlodipine and quetiapine overdose.
- To evaluate the efficacy of angiotensin II (Ang II) as a salvage therapy in this scenario.
Main Methods:
- A 38-year-old male intentionally ingested large amounts of amlodipine and quetiapine.
- The patient developed refractory shock despite maximal conventional therapies, including vasopressors, calcium, and insulin.
- Exogenous angiotensin II (Ang II) was administered as a last resort.
Main Results:
- Angiotensin II administration led to a significant improvement in mean arterial pressure (MAP) and hemodynamic stabilization.
- Other vasopressors were successfully weaned, and insulin therapy was reduced.
- This intervention proved effective when standard treatments failed.
Conclusions:
- Angiotensin II demonstrated potential as a salvage therapy for severe amlodipine and quetiapine-induced refractory shock.
- This case underscores the utility of Ang II in managing complex polysubstance ingestions unresponsive to conventional treatments.
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