Case 24-2006: A 40-year-old woman with hypotension after an overdose of amlodipine

New England Journal of Medicine

Volumn 355, Issue 6, 2006, Pages 602-611

  Harris, N Stuart ^a,b  

^a MASSACHUSETTS GENERAL HOSPITAL   (United States)

^b HARVARD MEDICAL SCHOOL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AMLODIPINE; CALCIUM CHLORIDE; DOPAMINE; GLUCAGON; GLUCONATE CALCIUM; INSULIN; LORAZEPAM; NORADRENALIN; ONDANSETRON; SUXAMETHONIUM; CALCIUM; CALCIUM CHANNEL BLOCKING AGENT; CARDIOTONIC AGENT;

ADULT; ANAMNESIS; ARTICLE; BLOOD PRESSURE MONITORING; CASE REPORT; CENTRAL VENOUS CATHETERIZATION; CLINICAL FEATURE; DRUG OVERDOSE; EMERGENCY WARD; FEMALE; HUMAN; HYPOTENSION; PHYSICAL EXAMINATION; PRIORITY JOURNAL; SUICIDE ATTEMPT; SYMPTOMATOLOGY; CHEMICALLY INDUCED DISORDER; CLINICAL OBSERVATION; CLINICAL STUDY; DIAGNOSIS; ELECTROCARDIOGRAPHY; EMERGENCY TREATMENT; INTOXICATION; MULTIMODALITY CANCER THERAPY;

ADULT; AMLODIPINE; CALCIUM; CALCIUM CHANNEL BLOCKERS; CARDIOTONIC AGENTS; COMBINED MODALITY THERAPY; ELECTROCARDIOGRAPHY; EMERGENCY TREATMENT; FEMALE; HUMANS; HYPOTENSION; INSULIN; OVERDOSE; SUICIDE, ATTEMPTED;

EID: 33746863766     PISSN: 00284793     EISSN: 15334406     Source Type: Journal    
DOI: 10.1056/NEJMcpc069016     Document Type: Article

References (37)

1. Watson WA, Litovitz TL, Rodgers GC Jr, et al. 2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2005;23:589-666.
2. Chyka PA, Seger D. Position statement: single-dose activated charcoal. J Toxicol Clin Toxicol 1997;35:721-41.
3. Hockerman GH, Peterson BZ, Johnson BD, Catterall WA. Molecular determinants of drug binding and action on L-type calcium channels. Annu Rev Pharmacol Toxicol 1997;37:361-96.
4. Katz AM. Cardiac ion channels. N Engl J Med 1993;328:1244-51.
5. Pearigen PD, Benowitz NL. Poisoning due to calcium antagonists: experience with verapamil, diltiazem and nifedipine. Drug Saf 1991;6:408-30.
6. Brunton LL, Lazo JS, Parker KL, Buxton IL, Blumenthal D, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 11th ed. New York: McGraw-Hill, 2005.
7. Kawai C, Konishi T, Matsuyama E, Okazaki H. Comparative effects of three calcium antagonists, diltiazem, verapamil and nifedipine, on the sinoatrial and atrioventricular nodes: experimental and clinical studies. Circulation 1981;63:1035-42.
8. Hollingshead LM, Faulds D, Fitton A. Bepridil: a review of its pharmacological properties and therapeutic use in stable angina pectoris. Drugs 1992;44:835-57.
9. Howarth DM, Dawson AH, Smith AJ, Buckley N, Whyte IM. Calcium channel blocking drug overdose: an Australian series. Hum Exp Toxicol 1994;13:161-6.
10. Kenny J. Treating overdose with calcium channel blockers. BMJ 1994;308:992-3.
11. Buckley NA, Whyte IM, Dawson AH. Overdose with calcium channel blockers. BMJ 1994;308:1639.
12. Bower JO, Mengle HAK. The additive effects of calcium and digitalis: a warning with a report of two deaths. JAMA 1936;106:1151-3.
13. Erickson FC, Ling LJ, Grande GA, Anderson DL. Diltiazem overdose: case report and review. J Emerg Med 1991;9:357-66.
14. Kline JA, Leonova E, Raymond RM. Beneficial myocardial metabolic effects of insulin during verapamil toxicity in the anesthetized canine. Crit Care Med 1995;23:1251-63.
15. Farah AE, Alousi AA. The actions of insulin on cardiac contractility. Life Sci 1981;29:975-1000.
16. Kline JA, Raymond RM, Schroeder JD, Watts JA. The diabetogenic effects of acute verapamil poisoning. Toxicol Appl Pharmacol 1997;145:357-62.
17. Devis G, Somers G, Van Obberghen E, Malaisse WJ. Calcium antagonists and islet function. I. Inhibition of insulin release by verapamil. Diabetes 1975;24:247-51.
18. Salhanick SD, Shannon MW. Management of calcium channel antagonist overdose. Drug Saf 2003;26:65-79.
19. Yuan TH, Kerns WP II, Tomaszewski CA, Ford MD, Kline JA. Insulin-glucose as adjunctive therapy for severe calcium channel antagonist poisoning. J Toxicol Clin Toxicol 1999;37:463-74.
20. Boyer EW, Duic PA, Evans A. Hyperinsulinemia/euglycemia therapy for calcium channel blocker poisoning. Pediatr Emerg Care 2002;18:36-7.
21. Boyer EW, Shannon M. Treatment of calcium-channel-blocker intoxication with insulin infusion. N Engl J Med 2001;344:1721-2.
22. Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006;354:449-61.
23. Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345:1359-67.
24. Quezado Z, Lippmann M, Wertheimer J. Severe cardiac, respiratory, and metabolic complications of massive verapamil overdose. Crit Care Med 1991;19:436-8.
25. Orr GM, Bodansky HJ, Dymond DS, Taylor M. Fatal verapamil overdose. Lancet 1982;2:1218-9.
26. Watling SM, Crain JL, Edwards TD, Stiller RA. Verapamil overdose: case report and review of the literature. Ann Pharmacother 1992;26:1373-8.
27. Walter FG, Frye G, Mullen JT, Ekins BR, Khasigian PA. Amelioration of nifedipine poisoning associated with glucagon therapy. Ann Emerg Med 1993;22:1234-7.
28. Wolf LR, Spadafora MP, Otten EJ. Use of amrinone and glucagon in a case of calcium channel blocker overdose. Ann Emerg Med 1993;22:1225-8.
29. Kissling G, Brilla C, Vogt M, Jacob R. Haemodynamic effects of amrinone in the anaesthetized pig. Eur Heart J 1988;9:800-10.
30. Krenzelok EP, McGuigan M, Lheur P. Position statement: ipecac syrup. J Toxicol Clin Toxicol 1997;35:699-709.
31. Buckley N, Dawson AH, Howarth D, Whyte IM. Slow-release verapamil poisoning: use of polyethylene glycol wholebowel lavage and high-dose calcium. Med J Aust 1993;158:202-4.
32. Barceloux D, McGuigan M, Hartigan-Go K. Position statement: cathartics. J Toxicol Clin Toxicol 1997;35:743-52.
33. Romano G, Barbera N, Rossitto C, Spadaro G. Lethal diltiazem poisoning. J Anal Toxicol 2002;26:374-7.
34. Ramoska EA, Spiller HA, Myers A. Calcium channel blocker toxicity. Ann Emerg Med 1990;19:649-53.
35. Ramoska EA, Spiller HA, Winter M, Borys D. A one-year evaluation of calcium channel blocker overdoses: toxicity and treatment. Ann Emerg Med 1993;22:196-200.
36. Frierson J, Bailly D, Shultz T, Sund S, Dimas A. Refractory cardiogenic shock and complete heart block after unsuspected verapamil-SR and atenolol overdose. Clin Cardiol 1991;14:933-5.
37. Hendren WG, Schieber RS, Garrettson LK. Extracorporeal bypass for the treatment of verapamil poisoning. Ann Emerg Med 1989;18:984-7.