Effective Management of Severe Amlodipine/Atenolol Overdose with Intravenous Calcium, Hyperinsulinemic Euglycemia Therapy, and Continuous Veno-Venous Hemodialysis: A Case Report.

IF 1 Q3 MEDICINE, GENERAL & INTERNAL American Journal of Case Reports Pub Date : 2024-07-08 DOI:10.12659/AJCR.943777
Cong Tan Nguyen, Van Cuong Bui, Ngoc Son Do, Thi Huong Giang Bui, The Thach Pham, Tuan Phong Hoang, Duc Trieu Ho
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Abstract

BACKGROUND Amlodipine, a calcium channel blocker, and atenolol, a beta blocker, are commonly used as a fixed drug combination (FDC) to treat hypertension. Intentional or non-intentional overdose of amlodipine-atenolol results in hypotension and myocardial depression with a high risk of mortality. This report describes a 64-year-old man with an overdose of amlodipine-atenolol, presenting as an emergency with hypotension, bradycardia, and severe metabolic acidosis. He was successfully treated with intravenous calcium chloride infusion, hyperinsulinemia euglycemia therapy (HIE), and continuous veno-venous hemodialysis (CVVHD). CASE REPORT A 64-year-old man was diagnosed with essential hypertension 1 week prior to the admission. He had been prescribed 1 FDC tablet of amlodipine and atenolol (5+50 mg) per day; however, he took 1 table of the FDC per day for 3 days and then took 3-4 tablets each day during the next 4 days. He was brought to the hospital with hypotension, bradycardia, and severe metabolic acidosis and was diagnosed with amlodipine-atenolol overdose. He was treated with intravenous calcium chloride infusion, HIE, and CVVHD. His hemodynamics started to improve after administering these therapies for 6 h. Inotropes were gradually tapered off and stopped. He was extubated on day 5 and recovered completely. CONCLUSIONS This report shows the serious effects amlodipine-atenolol overdose and the challenges of emergency patient management. An overdose of FDC of amlodipine and atenolol can cause cardiovascular collapse and severe metabolic acidosis. Timely and aggressive management with intravenous calcium infusion, HIE, and CVVHD is essential.

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通过静脉注射钙剂、高胰岛素血症治疗和持续静脉血液透析有效控制严重氨氯地平/替诺洛尔过量:病例报告。
背景 钙通道阻滞剂氨氯地平和β受体阻滞剂阿替洛尔通常作为固定药物组合(FDC)用于治疗高血压。有意或无意过量服用氨氯地平-阿替洛尔会导致低血压和心肌抑制,并有很高的致死风险。本报告描述了一名 64 岁男性因过量服用氨氯地平-阿替洛尔而出现低血压、心动过缓和严重代谢性酸中毒的急症。经静脉输注氯化钙、高胰岛素血症优生疗法(HIE)和持续静脉-静脉血液透析(CVVHD)治疗后,他获得了成功。病例报告 一名 64 岁的男性患者在入院一周前被诊断出患有原发性高血压。医生给他开的处方是每天 1 片氨氯地平和阿替洛尔(5+50 毫克)的复方制剂,但他连续 3 天每天服用 1 片复方制剂,随后 4 天每天服用 3-4 片。他因低血压、心动过缓和严重代谢性酸中毒被送到医院,被诊断为氨氯地平-阿替洛尔过量。他接受了氯化钙静脉注射、HIE 和 CVVHD 治疗。在使用这些疗法 6 小时后,他的血流动力学开始改善。第 5 天拔除气管,并完全康复。结论 本报告显示了氨氯地平-阿替洛尔过量的严重后果和急诊患者管理的挑战。过量服用氨氯地平和阿替洛尔的 FDC 会导致心血管衰竭和严重的代谢性酸中毒。及时、积极地进行静脉输钙、HIE 和 CVVHD 处理至关重要。
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来源期刊
American Journal of Case Reports
American Journal of Case Reports Medicine-Medicine (all)
CiteScore
1.80
自引率
0.00%
发文量
599
期刊介绍: American Journal of Case Reports is an international, peer-reviewed scientific journal that publishes single and series case reports in all medical fields. American Journal of Case Reports is issued on a continuous basis as a primary electronic journal. Print copies of a single article or a set of articles can be ordered on demand.
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