![]() ![]() Toxic levels of amlodipine create the overdose’s specific findings due to the end-organ effects on the heart, blood vessels, and pancreas. This inhibition occurs as L-type calcium channels are blocked. In the following sections, we will review the offending agent’s unique characteristics, standard medical therapies, and rescue therapies in patients who are refractory to medical treatments.Īmlodipine is a dihydropyridine calcium channel blocker that inhibits the influx of calcium in the peripheral and coronary vasculature resulting in vasodilation. Resuscitative efforts are aimed at counteracting the effects of the medication. These overdoses present with vasodilatory shock, ultimately leading to cardiovascular collapse. This case highlights the difficulties providers encounter with ingestions of dihydropyridine calcium channel blockers, specifically amlodipine. She was pronounced dead less than 24 hours into her hospital stay, 25 hours from the time of her ingestion. Resuscitation with standard ACLS measures occurred, but the team was unable to obtain ROSC. Plasma exchange therapy was considered, but the patient suffered an asystolic arrest, presumably due to her worsening hypotension and hypoxemia. The patient continued to decline requiring methylene blue for refractory hypotension. Despite these measures, the patient had a refractory acidosis and progressive oliguria, necessitating CRRT. Additional therapies were started including high dose insulin therapy, lipid emulsion, therapy, calcium gluconate drip, and a glucagon drip. Her hypotension continued to worsen, so vasopressin and epinephrine were added for hemodynamic support. Shortly after arriving to the MICU, the patient became altered and was intubated for airway protection. Before departing the ED, the patient became hypotensive despite fluid resuscitation, and was started on a peripheral norepinephrine drip. The MICU was notified about the patient and accepted the patient under their service. Upon arrival to the ED, the patient was given activated charcoal for her recent overdose. Her extremities were warm and well perfused with palpable peripheral pulses. Her cardiopulmonary exam was unremarkable. The patient was slightly anxious but nontoxic appearing and in no apparent distress. Other than some mild nausea, the patient was feeling in her usual state of health. The patient arrived at the ED less than two hours from the time of her ingestion. Once this ingestion was discovered, family members called EMS for evaluation and transportation to the hospital. Due to miscommunication/misinterpretation, the patient mistakenly ingested one entire bottle (300 mg). Her daughter-in-law reviewed her medications and instructed the patient to take amlodipine once a day. The patient recently established care with a primary care provider and was prescribed amlodipine for her hypertension. The patient is a Fulani-speaking female in her 70s with a past medical history of hypertension and hyperlipidemia who presented to the emergency department (ED) after a non-intentional amlodipine overdose. Ultrasound Welcome Policies Scanning School Machines Machine Care Ultrasound of the Month Faculty Credentialing Resources QpathE Workflow Jewish Hospital Ultrasound Contact.Procedures Procedural Education Arterial Line Central Line Chest Tube Cricothyrotomy Lumbar Puncture Procedural Sedation Regional Anesthesia Transvenous Pacemaker IC Cordes / Airway.Operations Logistics SPAMs UC Policies WCMC Operations WCMC Consults.Resident Education Grand Rounds Bread & Butter EM Electives Global Health Journal Club Social Media Primer Wellness.Prehospital EMS Air Care Orientation Air Care Education Air Care Equipment Air Care Medications Air Care Procedures Air Care Quick Reference Air Care Nuts & Bolts Air Care Safety Air Care Secure.Emergency KT EmergencyKT CC Evaluation Guidelines Clinical Practice Guidelines Common Forms Observation Protocols Outpatient Follow Up/Resources Antibiograms.Air Care Series: Calcium Channel Blocker Overdose - Taming the SRU Top Taming the SRU ![]()
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