Albumin human/amlodipine/methylthioninium chloride
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Various toxicities: case report A 68-year-old man developed non-cardiogenic pulmonary oedema, decreased urine output, low mean arterial pressure (MAP) and hyperdynamic left ventricle due to amlodipine poisoning following amlodipine overdose in a suicide attempt. Additionally, he exhibited lack of efficacy following treatment with albumin human and methylthioninium chloride for low MAP. The man presented to the hospital 15 hours after amlodipine overdose. He ingested amlodipine in a suicide attempt. Upon arrival to the hospital, laboratory investigation revealed MAP of 55mm Hg, lactate level of 5.8 mmol/L, heart rate (HR) of 115 bpm and creatinine of 152 µmol/L. The man was treated with unspecified crystalloids. After 24 hrs of amlodipine ingestion, he became dyspneic with inspiratory crackles. He was diagnosed with non-cardiogenic pulmonary oedema. His lactate levels normalised. However, MAP and HR levels remained unchanged. A transthoracic echocardiogram (TTE) revealed a hyperdynamic left ventricle. He was treated with furosemide and oxygen. Thereafter, his pulmonary symptoms improved. He was initiated on norepinephrine. At 40 hours, he was transferred to the ICU for a persistently low MAP and decreasing urinary output. His norepinephrine dose was escalated along with addition of vasopressin. He was treated with methylthioninium chloride [methylene blue] 1 mg/kg as a single bolus and 250mL of albumin human [albumin] 5%. However, despite the treatment, his MAP did not change. Repeat TTE showed persistent hyperdynamic state. He rapidly desaturated and required emergency intubation for pulmonary oedema at 43 hours post-amlodipine ingestion. Thereafter, he was maintained on norepinephrine, vasopressin and insulin. Following these treatments, his condition stabilised and eventually improved. At 48 hours post-amlodipine ingestion, his amlodipine blood concentration was found to be 0.13 µg/mL. Following full recovery, he was extubated and was discharged from the ICU 96 hours post-amlodipine ingestion. The noncardiogenic pulmonary oedema, decreased urine output, low MAP and hyperdynamic left ventricle were considered to have developed due to amlodipine poisoning following amlodipine overdose. Alebring J, et al. Non-cardiogenic pulmonary edema in amlodipine poisoning: The lesser evil?. Clinical Toxicology 58: 629-630, No. 6, 2020. Available from: URL: http:// 803503392 doi.org/10.1080/15563650.2020.1741981 [abstract]
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Reactions 26 Sep 2020 No. 1823
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