Bilateral blindness secondary to optic nerve ischemia from severe amlodipine overdose: a case report

Abstract

BackgroundCalcium channel blockers are commonly prescribed medications; calcium channel blocker overdose is becoming increasingly prevalent. The typical presentation of a calcium channel blocker overdose is hypotension and decreased level of consciousness. We describe a case of a calcium channel blocker overdose that led to bilateral cortical blindness, a presentation that has not previously been reported.Case presentationA 49-year-old white woman with known bilateral early optic atrophy presented to our hospital with hypotension and obtundation following a known ingestion of 150 mg of amlodipine. She was transferred to our intensive care unit where she was intubated, mechanically ventilated, and required maximal vasopressor support (norepinephrine 40 mcg/minute, epinephrine 40 mcg/minute, and vasopressin 2.4 units/hour) along with intravenously administered crystalloid boluses. Despite these measures, she continued to deteriorate with persistent hypotension and tachycardia, as well as anuria.Intralipid emulsion therapy was subsequently administered to which no initial response was observed. A chest X-ray revealed diffuse pulmonary edema; intravenous diuresis as well as continuous renal replacement therapy was initiated.Following the initiation of continuous renal replacement therapy, her oxygen requirements as well as urine output began to improve, and 3 days later she was liberated from mechanical ventilation. Following extubation, she complained of new onset visual impairment, specifically seeing only red-green colors, but no objects. An ophthalmologic examination revealed that this was due to bilateral optic atrophy from prolonged hypotension during the first 24 hours after the overdose.ConclusionPersistent hypotension in the setting of a calcium channel blocker overdose can lead to worsening optic atrophy resulting in bilateral cortical blindness.

Acute ischemic optic neuropathy in a case of heroin overdose

“…Our patient presented with findings most supportive of AION and PION in the setting of heroin overdose. Ischemic optic neuropathy has been reported in cases with methamphetamine use [22] , amlodipine overdose [23] , and cocaine use [24] . But there is no reported case of ION in the setting of heroin / opioid use.…”

Study of the Distribution of Amlodipine in Organs of Poisoned Animals

“…The main manifestations of amlodipine overdose are hyperglycemia, metabolic acidosis, electrolyte imbalance, sinus bradycardia, collapse [1]. According to the literature sources, amlodipine in case of overdose can provoke the development of breast cancer [6], cause ischemia of the optic nerve [7]. Deadly poisoning with amlodipine may accompany drug overdoses or suicidal cases.…”