Treatment of Severe Amlodipine Toxicity With Molecular Adsorbent Recirculating System

Pinto, Venessa; Wenderfer, Scott E.; Morris, Jennifer; Akcan-Arikan, Ayse

doi:10.1016/j.ekir.2018.09.017

Cited by 7 publications

(9 citation statements)

References 13 publications

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“… 4 , 14 , 16 - 19 Pinto et al reported the case of a pediatric patient treated with MARS in tandem with ECMO. 15 They demonstrated reduction in CCB levels and improvements in hemodynamic instability after each procedure. Calcium channel blocker levels were noted to rise between MARS treatments due to rebound effect as blood-tissue drug equilibrium occurs.…”

Section: Discussionmentioning

confidence: 91%

“…MARS or single-pass albumin dialysis (SPAD) may provide a therapeutic option as a salvage therapy following CCB ingestion. 6 , 14 - 16 We present a case of pediatric amlodipine toxicity with refractory cardiovascular collapse and successful treatment of SPAD. We aim to describe the clinical implications of amlodipine toxicity, clinical and pharmacologic challenges with adult-sized pediatric patients, and successful treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

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Single-Pass Albumin Dialysis as Rescue Therapy for Pediatric Calcium Channel Blocker Overdose

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Berg

Montange

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

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Calcium channel blocker ingestions remain one of the leading causes of death related to cardiovascular medication ingestion in both adults and pediatric patients. We report a case of a 17-year-old, 103 kg female presenting after an intentional polypharmacy ingestion, including 500 to 550 mg of amlodipine. She presented with profound vasoplegia and cardiovascular collapse requiring high-dose inotropes and eventual life support with extracorporeal membrane oxygenation (ECMO). Current available treatments, designed for adults, including lipid emulsion and methylene blue, provided no sustained clinical improvement. This resulted in the initiation of single-pass albumin dialysis (SPAD). We aim to describe the clinical implications, amlodipine toxic dose effects, and clinical challenges associated with large pediatric patients and high-dose medications. We also discuss several challenges encountered related to dosing and concentration of medications, which led to fluid overload. Given the ongoing obesity epidemic, we routinely see pediatric patients of adult size. This will continue to challenge pediatric use of adult dosing and concentrations to avoid excessive fluid administration for high-dose medications, such as insulin and vasoactive agents. To our knowledge, this is the first successful case of using SPAD in conjunction with ECMO for salvage therapy after refractory life-threatening calcium channel blocker toxicity.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Single-Pass Albumin Dialysis as Rescue Therapy for Pediatric Calcium Channel Blocker Overdose

Essink

Berg

Montange

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

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“…Calcium blockers are divided in three main chemical classes where each of them present different affinity for cardiac tissue and blood vessels [6]: 1) Phenylalkylamine class (verapamil); 2) Benzothiazepine class (diltiazem); and 3) Dihydropyridines where it is included amlodipine, nicardipine, nifedipine, etc.…”

Section: Discussionmentioning

confidence: 99%

Non-Cardiogenic Pulmonary Edema With Refractory Hypotension in a Child From Amlodipine Overdoses

et al. 2020

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Intoxications from calcium blockers are not common in daily pediatric practice, but often they can be life-threatening and result fatal for children. Non-cardiogenic edema in children as a result of overdose from amlodipine is rare. In this article, we want to present a case of an intentional intoxication from overdose of amlodipine in a teen girl who suffered complications with refractory hypotension and non-cardiogenic pulmonary edema after 2 days from ingestion. This article wants to highlight the reporting of this rare life-threatening complication because of overdose. It will also focus on the successful supportive treatment with liquids, salt of calcium, vasopressors, glucagon, intra-lipids, mechanical ventilation and the superiority of using highdose insulin-euglycemia in the concomitant refractory hypotension.

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“…As CCBs are highly protein bound and have a large volume of distribution, they are poorly removed by conventional hemodialysis. Molecular absorbent recirculation system (MARS) has been shown to be beneficial in cases of overdose of highly protein-bound CCBs, with decrease in vasopressor requirements noted in many cases shortly after initiation 9,10,12,[16][17][18] . Pinto et al reported the case of a pediatric patient treated with MARS in tandem with ECMO12.…”

Section: Methods Use Of Mars and Spad On Ccb Ingestionmentioning

confidence: 99%

“…The use of albumin dialysis in the management of CCB is controversial and is not currently recommended by expert groups due to the lack of clinical pharmacokinetic data 6,24 . Although multiple studies have shown clinical improvements in CCB following albumin dialysis [9][10][11][12]16,[18][19][20][21][22][23]25 , it has also been suggested that hemodynamic improvements may be due to removal of endogenous vasodilatory substances, such as nitric oxide and inflammatory cytokines, rather than directly through clearance of toxins and acid-base balance correction 9,17 . Although plasma and dialysate drug concentrations were not measured in our study, we saw a correlation between albumin concentration and hemodynamic improvement.…”

Section: Methods Use Of Mars and Spad On Ccb Ingestionmentioning

confidence: 99%

Abstracts

2022

Journal of Investigative Medicine

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Introduction/Background Cigarette smoking (CS) is the major cause of Chronic Obstructive Pulmonary Disease (COPD). Ecigarettes are considered by some as a safer alternative; however, inhalation of nicotine-containing e-cigarettes can also cause pathophysiologic changes, and 'vaping' of some substances has led to severe lung damage. Our group has previously identified the effect of CS or e-cigarettes in lung endothelial apoptosis and mitochondrial dysfunction. Objective(s) This study seeks to characterize the effects of CS or E-cig in lung endothelial dysfunction. Methods An important marker of mitochondrial dysfunction is excess mitochondrial ROS (mitoROS), and its production in lung ECs was assessed using MitoSOX reagent. Cytoskeleton rearrangement of ECs upon e-cigarette was assessed by immunofluorescence. Lung EC was exposed to E-cigarette extract (50 mg/ml), resulting in disruption of endothelial permeability assessed by Electric Cell Substrate Impedance (ECIS) and Transwell assay. Atomic Force Microscopy (AFM) was used to probe the biomechanical responses of the manipulated ECs upon e-cigarette challenge. Results Blocking mitoROS with Mito-TEMPO (10 mM, 3 h), a cell-permeable antioxidant, decreased mitochondrial superoxide production. We next assessed the role of Mito-TEMPO on Ecigarette-induced endothelial permeability. Pretreatment with Mito-TEMPO provided barrier protection upon e-cigarette challenge. These results suggest a key role of mitoROS in ecigarette-induced endothelial permeability. E-cigarette exposure induces cytoskeleton rearrangement leading to gap formation in lung EC, as well as alters elastic properties of ECs as measured by AFM. Conclusion This study provides novel mitochondrial and biophysical characterization of the effects of e-cigarette exposure on lung EC and advances our understanding of its pathophysiologic effects.

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Treatment of Severe Amlodipine Toxicity With Molecular Adsorbent Recirculating System

Cited by 7 publications

References 13 publications

Single-Pass Albumin Dialysis as Rescue Therapy for Pediatric Calcium Channel Blocker Overdose

Single-Pass Albumin Dialysis as Rescue Therapy for Pediatric Calcium Channel Blocker Overdose

Non-Cardiogenic Pulmonary Edema With Refractory Hypotension in a Child From Amlodipine Overdoses

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