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Calciumchannel blockeroverdose: Experiencewith amlodipine
SupradipGhoshand MrinalSircar
Author informationCopyrightand LicenseinformationDisclaimer
Abstract
Amlodipine overdoseisonlyscarcelyreportedfromIndia.We reporttwocasesof nearfatal
Amlodipine overdose managedinourICUwithfluid,vasopressors, calciuminfusionand
Glucagon. Literatureisreviewedandothertreatment modalitiesdiscussed.
Keywords:Amlodipine overdose,calcium,calciumchannel blocker,glucagon, hyperinsulinemi
euglycemia
Introduction
Calciumchannelblockersarethe leadingcauseofcardiovasculardrugoverdoseandare
responsiblefor48% ofdeathsrelatedtocardiovasculardrugexposure.[1]Treating patients
withoverdoseofthese medicationscanchallengeeventhe mostexperiencedphysician.The
difficultyarises becausepatientsseverelypoisonedwithcalciumchannel blockersmayhave
profoundrefractorybradycardiaandhypotension.[1] Reportsofcalciumchannelblocker
overdosearescarceinIndianliterature.WereporttwocasesofAmlodipineoverdosetreated
inourICU.
Goto:
Case Reports
Case 1
A 25-year-old physiotherapistwas broughttoour hospitalwith complaintsof recurrent
vomitingfollowing ingestionof 100mgofAmlodipineandfewsustainedreleasetabletsof
Diclofenac,four hoursearlier.Initiallyshewastakentoa localhospital,where gastriclavage
was performedandshewastreatedwith intravenousfluidsand Dopamineinfusioninview
of lowbloodpressure.Therewas nohistoryofsyncope/seizure,dyspnoeaorpalpitations.
ShewasaknowncaseofbronchialasthmaoninhaledSalbutamolasandwhen required.On
examination,intheICUofour hospital,shewas drowsybutarousableon lightstimuli.She
was palewithcold,clammyextremities,herheartratewas80/min,regular,sinusrhythmand
herbloodpressurewas 60mmHgsystolic.Therewere noheartmurmursorgallop,and her
lungswereclearonauscultation.Abdominal examination revealedmildepigastric
tenderness. Herinitialhemogram,liverrenalfunctiontests,ABGandelectro
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