Atenolol/amlodipine overdose

Abstract

A 35-year-old woman developed acute renal failure, anuria, hypotension, metabolic acidosis, second degree AV block, Mobitz type II following overdose of atenolol and amlodipine.The woman presented eight hours after ingestion of 100 tablets of amlodipine 10 mg and atenolol 50 mg with a suicidal intention. She was in altered sensorium with E2, V2, M4 on Glasgow coma scale. Initial examination revealed woman with blood pressure of 70/50 mmHg, pulse 62 bpm and respiratory rate 32/min. She had tachycardia and tachypnoea with prolonged expiration. The woman was started on adrenaline, dopamine, vasopressin and was immediately put on mechanical ventilator. She received calcium carbonate, glucagon, insulin with continuous infusion of glucose and potassium. The woman was anuric and had worsening metabolic acidosis and declining blood pressure.She was put on continuous veno‑venous hemodiafiltration with heparin as an anticoagulant. Her sensorium and urine output improved gradually and blood pressure normalised after 120 hours of treatment. The woman was extubated and pressors were discontinued.Author comment: "We present a patient who consumed large doses of BB and CCB with suicidal intent. She was successfully managed by continuous veno‑venous hemodiafiltration (CVVHDF)." "The indications for performing CVVHDF in our patient were acute renal failure with anuria and metabolic acidosis with hypotension. The metabolic acidosis was due to lactic acidosis due to shock and acidosis due to acute renal failure." Sandeep P, et al. Atenolol and amlodipine combination overdose managed with continuous venovenous hemodiafiltration: A case report. Indian Journal of Nephrology