Amlodipine/atenolol overdose
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Various toxicities: case report A 66-year-old man developed bradycardia, hypocalcaemia, hypotension, cardiac arrest, shock, acute renal failure and metabolic acidosis due to drugs toxicities following an overdose of amlodipine/atenolol overdose. The man had been receiving amlodipine/atenolol 5mg/50mg for hypertension. He presented at around 11:30pm on 02 November 2016 due to three episodes of vomiting followed by sudden fall while standing. His BP was 100/60mm Hg. On the next day, he again presented with similar episodes. On further investigation, he admitted that he took 25 tablets of amlodipine/ atenolol at around 8.30pm on 02 November 2016. At around 4pm, he complained of decreased urine output, and he was drowsy. His examination showed heart rate of 48 bpm, BP of 80/60mm Hg, respiratory rate of 22 breaths/minute and oxygen saturation of 88%. ECG showed sinus bradycardia along with tall R-wave with strain pattern in precordial leads. The man was treated with atropine along with gastric lavage, normal saline, norepinephrine and dobutamine. His ionized calcium was 0.56 mmol/L. He received calcium gluconate. His lab tests showed blood urea of 47 mg/dL, serum creatinine of 2 mg/dL and lactate of 2.2. Arterial blood gas analysis showed metabolic acidosis. At around 6:30pm, he experienced shortness of breath and palpitation owed by cardiac arrest. He revived after cardiopulmonary resuscitation, and he was put on ventilator. Fluid resuscitation was continued. Additionally, he was treated with isoprenaline, etofylline/theophylline and salbutamol. He also received soya-oilemulsion due to persistent shock and bradycardia. Subsequently, his condition improved with improved urine output, normal creatinine and normalised ECG findings. He was extubated on sixth day. On eighth day, he was discharged in stable condition. Tale S, et al. A case of life-threatening amlodipine and atenolol overdose. Indian Journal of Critical Care Medicine 23: 281-283, No. 6, Jun 2019. Available from: URL: http:// doi.org/10.5005/jp-journals-10071-23181 803506943
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Reactions 17 Oct 2020 No. 1826
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