A Survival Case in a Severe Amlodipine Intoxication

Abstract

Calcium channel blockers (CCBs) are prescribed in a wide variety of cardiovascular conditions. Nevertheless, they remain a major cause of cardiovascular drug overdose that often leads to a lethal outcome. We report the case of an intoxication with amlodipine, which caused severe hypotension, in a young woman. The patient was initially treated with fluids, calcium gluconate, and Dobutamine without effect. She then received hyperinsulinemia euglycemia therapy. A rise in blood pressure (BP) was observed two hours after insulin was started. The next day, the insulin infusion was stopped and seven days later the patient was discharged from the hospital after psychiatric consultation. The positive inotropic effect of insulin therapy in our patient supports previous findings that suggest its use as a first-line therapy in the management of CCBs overdose.

Once was not enough: A case report of the concomitant intoxication of amlodipine (calcium channel blocker) and clonazepam (benzodiazepine)

“…Hyperinsulinemic euglycemia in CCBs overdose has been recommended as an appropriate strategy for its management, and had been beneficial in some case reports. 17,18 The insulin effect is by increasing ionized calcium level, exerting independent ionotropic effect, improving myocardial utilization of carbohydrates, and improving hyperglycemic acidotic state. 19 Flumazenil is a benzodiazepine analog, which antagonizes benzodiazepines by binding to the same GABA-A receptor.…”

Amlodipine Overdose - A Tricky Case Scenario

“…1 That explains why our patient presented with a refractory hypotension without cardiac conduction defects. 2 Treating patients with overdose of CCBs can challenge even experienced physicians. The difficulty arises because patients severely poisoned with CCBs can develop profound refractory bradycardia, hypotension and either cardiogenic or non-cardiogenic pulmonary oedema.…”