Vasopressin for persistent hypotension due to amlodipine and olmesartan overdose: A case report
| Autor: | Susumu Matsushime, Akira Kuriyama |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Vasopressin
Vasopressins ACE angiotensin-converting enzyme medicine.drug_class Case Report Calcium channel blocker urologic and male genital diseases Norepinephrine (medication) 03 medical and health sciences 0302 clinical medicine medicine Amlodipine CCB calcium channel blocker business.industry General Medicine ARB angiotensin II receptor blocker Drug overdose Blood pressure Epinephrine 030220 oncology & carcinogenesis Anesthesia Toxicity ED emergency department 030211 gastroenterology & hepatology Surgery Olmesartan business hormones hormone substitutes and hormone antagonists Angiotensin receptor antagonists medicine.drug |
| Zdroj: | Annals of Medicine and Surgery |
| ISSN: | 2049-0801 |
| DOI: | 10.1016/j.amsu.2021.102292 |
| Popis: | Background While there are consensus recommendations for managing calcium channel blocker (CCB) toxicity, reports on angiotensin II receptor blocker (ARB) toxicity and management are limited. Herein, we report a case of catecholamine-refractory hypotension due to CCB and ARB overdose. Case presentation A 54-year-old woman with underlying hypertension was brought to the emergency department after she attempted suicide by ingesting 345 mg of amlodipine, a CCB, and 340 mg of olmesartan, an ARB. She was hypotensive, which was considered vasodilatory because of high cardiac and low systemic vascular resistance indices. Hypotension persisted despite the administration of norepinephrine and epinephrine. Intravenous calcium gluconate, glucagon, and high-dose insulin euglycemia therapy, which were initiated because CCB toxicity was suspected, failed to raise her blood pressure. The presence of normal anion-gap metabolic acidosis and the fact that the patient remained hypotensive suggested that the hypotension might have been due to the effect of ARB. Vasopressin was finally administered, which improved her hemodynamic status. She was weaned off all vasopressors on day 3. Discussion There is no consensus recommendation for ARB toxicity. Since chronic use of ARBs at conventional doses can block the sympathetic nervous and renin–angiotensin systems, catecholamines may not effectively increase blood pressure in cases of hypotension due to ARB overdose, for which vasopressin could be indicated. Conclusions Vasopressin could be an option for treating hypotension secondary to ARB and CCB toxicity when catecholamines and treatment for CCB toxicity fail. Highlights • Chronic use of ARBs blocks the sympathetic nervous and renin–angiotensin systems. • There is no consensus recommendation for angiotensin II receptor blocker (ARB) toxicity. • Catecholamines may not effectively raise blood pressure in hypotension due to ARB toxicity. • Vasopressin could be an option for treating hypotension secondary to ARB toxicity. |
| Databáze: | OpenAIRE |
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