Amlodipine poisoning revisited: Acidosis, acute kidney injury and acute respiratory distress syndrome

Abstract

We report the case of an 18-year-old girl presenting with shock following ingestion of 85 mg of amlodipine and 850 mg of atenolol with suicidal intent. Subsequently, the patient developed severe metabolic acidosis, acute kidney injury, and acute respiratory distress syndrome, which were managed conservatively. The patient ultimately made a full recovery. Given the popularity of amlodipine and atenolol as antihypertensive drugs in this part of the world, it is likely that more such cases will be encountered in the future. Physicians should be aware of the severe complications that can develop with amlodipine overdose.

A very rare side effect of amlodipine: non-cardiogenic pulmonary edema

“…To date, seven cases of amlodipine associated non-cardiogenic pulmonary edema have been reported (Table 1). [1][2][3][4][5][6] Similar to our case, most of the reported cases were young females and had hypotension at presentation. Of these, four needed short-term intubation without reported mortality.…”

“…Of these, four needed short-term intubation without reported mortality. [1][2][3][4][5][6] Intravenous fluids, inotropes, and calcium gluconate were the most commonly used treatments in reported cases of amlodipine associated pulmonary edema. Increased pulmonary capillary transudation secondary to precapillary vasodilation is probably the main mechanism responsible for amlodipine associated noncardiogenic pulmonary edema.…”

“…Increased pulmonary capillary transudation secondary to precapillary vasodilation is probably the main mechanism responsible for amlodipine associated noncardiogenic pulmonary edema. [1][2][3][4][5][6] In calcium channel blocker intoxications, activated charcoal administration or intestinal lavage with polyethylene glycol are recommended within 24 hours after drug intake. In addition to intravenous fluids, if necessary, inotropic drugs should be used for hypotension.…”

“…In addition to intravenous fluids, if necessary, inotropic drugs should be used for hypotension. [1][2][3][4][5][6]9] In certain cases, calcium infusions may improve contractility and hypotension. [10] In our case, we used activated charcoal for intestinal lavage, intravenous fluid, positive inotropic drugs, and intravenous calcium infusion.…”

“…Although peripheral edema is a well-known side effect of amlodipine, pulmonary edema associated with amlodipine is very rare. [1][2][3][4][5][6] Herein, we present a case of non-cardiogenic pulmonary edema associated with amlodipine overdose.…”