Intravenous Lipid Emulsion Treatment and High-Dose Amlodipine Intoxication: A Case Report

Abstract

Background: Calcium channel blockers (CCBs) are widely used for various indications such as hypertension, coronary artery disease, and certain cardiac arrhythmias. As they are frequently prescribed, overdoses are common. Our aim in this paper was to present a case of intoxication with amlodipine, captopril, and doxazosin where ILE treatment proved unsuccessful and to review literature for effectiveness of ILE therapy in amlodipine poisonings. Case Presentation: A 54-year-old female patient presented to the emergency department after taking 300 mg of amlodipine, 1000 mg of captopril, and 120 mg of doxazosin with suicidal intention. The patient was treated with gastric lavage, activated charcoal, calcium gluconate, hydration, vasopressor, inotrope, insulin and glucose, and intravenous lipid emulsion and transferred to intensive care unit at the 8th hour. Hemodynamics did not improve and the patient underwent plasmapheresis at the 10th hour. Patient was extubated and discharged without sequelae. Considering the pharmacokinetics of captopril and doxazosin, worsening of hemodynamics after 8 hours was related to amlodipine. Conclusion: While verapamil and diltiazem poisonings were generally reported to be successfully treated with intravenous lipid emulsion, salvage treatment with intravenous lipid emulsion was reported to be unsuccessful in the literature for amlodipine intakes of 280 mg or more.