Atenolol and amlodipine combination overdose managed with continuous venovenous hemodiafiltration: A case report

Sandeep, P; Ram, R; Sowgandhi, N; Reddy, Sheela; Katyarmal, DT; Ayan, Kumar, Bs,; Kumar, V Siva

doi:10.4103/0971-4065.133033

Cited by 5 publications

(1 citation statement)

References 15 publications

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“…For atenolol (n = 9), when hemodialysis was used, an increase in blood pressure was noted after the first treatment, with one exception [ 129 ]. Again, apparent improvement was slower with CKRT [ 120 , 127 , 128 ]. Dysrhythmias recurred in two patients, within two hours of ECTR cessation, requiring another session [ 13 , 15 ].…”

Section: Resultsmentioning

confidence: 99%

Extracorporeal treatment for poisoning to beta-adrenergic antagonists: systematic review and recommendations from the EXTRIP workgroup

et al. 2021

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Background β-adrenergic antagonists (BAAs) are used to treat cardiovascular disease such as ischemic heart disease, congestive heart failure, dysrhythmias, and hypertension. Poisoning from BAAs can lead to severe morbidity and mortality. We aimed to determine the utility of extracorporeal treatments (ECTRs) in BAAs poisoning. Methods We conducted systematic reviews of the literature, screened studies, extracted data, and summarized findings following published EXTRIP methods. Results A total of 76 studies (4 in vitro and 2 animal experiments, 1 pharmacokinetic simulation study, 37 pharmacokinetic studies on patients with end-stage kidney disease, and 32 case reports or case series) met inclusion criteria. Toxicokinetic or pharmacokinetic data were available on 334 patients (including 73 for atenolol, 54 for propranolol, and 17 for sotalol). For intermittent hemodialysis, atenolol, nadolol, practolol, and sotalol were assessed as dialyzable; acebutolol, bisoprolol, and metipranolol were assessed as moderately dialyzable; metoprolol and talinolol were considered slightly dialyzable; and betaxolol, carvedilol, labetalol, mepindolol, propranolol, and timolol were considered not dialyzable. Data were available for clinical analysis on 37 BAA poisoned patients (including 9 patients for atenolol, 9 for propranolol, and 9 for sotalol), and no reliable comparison between the ECTR cohort and historical controls treated with standard care alone could be performed. The EXTRIP workgroup recommends against using ECTR for patients severely poisoned with propranolol (strong recommendation, very low quality evidence). The workgroup offered no recommendation for ECTR in patients severely poisoned with atenolol or sotalol because of apparent balance of risks and benefits, except for impaired kidney function in which ECTR is suggested (weak recommendation, very low quality of evidence). Indications for ECTR in patients with impaired kidney function include refractory bradycardia and hypotension for atenolol or sotalol poisoning, and recurrent torsade de pointes for sotalol. Although other BAAs were considered dialyzable, clinical data were too limited to develop recommendations. Conclusions BAAs have different properties affecting their removal by ECTR. The EXTRIP workgroup assessed propranolol as non-dialyzable. Atenolol and sotalol were assessed as dialyzable in patients with kidney impairment, and the workgroup suggests ECTR in patients severely poisoned with these drugs when aforementioned indications are present.

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Section: Resultsmentioning

confidence: 99%

Extracorporeal treatment for poisoning to beta-adrenergic antagonists: systematic review and recommendations from the EXTRIP workgroup

et al. 2021

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Atenolol/amlodipine overdose

2014

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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

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Extracorporeal treatment for calcium channel blocker poisoning: systematic review and recommendations from the EXTRIP workgroup

Wong

Hoffman

Walsh

et al. 2021

Clinical Toxicology

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Atenolol and amlodipine combination overdose managed with continuous venovenous hemodiafiltration: A case report

Abstract: We present a patient of who ingested large dose of of atenolol and amlodipine and was treated successfully with continuous venovenous hemodiafiltration. Early recognition of indications for renal support and early initiation of the same is the key to successful management.

Cited by 5 publications

References 15 publications

Extracorporeal treatment for poisoning to beta-adrenergic antagonists: systematic review and recommendations from the EXTRIP workgroup

Extracorporeal treatment for poisoning to beta-adrenergic antagonists: systematic review and recommendations from the EXTRIP workgroup

Atenolol/amlodipine overdose

Extracorporeal treatment for calcium channel blocker poisoning: systematic review and recommendations from the EXTRIP workgroup

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