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Amlodipine/glucose/insulin Various toxicities following overdose: case report

An 18-year-old woman developed hyponatraemia, hypotension, pulmonary oedema, decreased level of consciousness following an overdose of amlodipine. She additionally exhibited worsening of hyponatraemia during treatment with insulin and glucose [duration of treatment to reaction onset not stated; not all routes and outcomes stated]. The woman presented to the emergency department following intentional ingestion of amlodipine 250mg. Her vital signs included BP 90/38mm Hg (hypotension), respiratory rate 18 breaths/minute, heart rate 117 bpm and oxygen saturation 98% (room air). Subsequent blood gas analysis showed pH 7.460, glucose 5.9 mmol/L and sodium 131 mmol/L. Blood test showed sodium 130 mmol/L (hyponatraemia), potassium 4.1 mmol/L, bicarbonate 22 mmol/L, chloride 99 mmol/L, creatinine 106 µmol/L and urea 8.1 mmol/L. The woman was initiated with Ringer’s lactate solution. A high dose euglycaemic therapy (HIET) with insulin and glucose [dextrose] was initiated after 10 hours of her presentation due to worsening hypotension. HIET was then titrated up with glucose [dextrose] 50% infusion running at 40 mL/hour. She was then admitted to high care unit. She continued to receive HIET. A blood gas analysis showed decreased sodium level to 118 mmol/L (worsening of hyponatraemia). Subsequently, she was intubated for decreased level of consciousness and pulmonary oedema despite fluid restriction. The hyponatraemia was treated with sodiumchloride [hypertonic saline]. HIET dose was decreased. Examinations were performed for hyponatraemia including serum osmolality 277 mmol/kg, urine osmolality 343 mmol/kg and urine sodium 13 mmol/L, which indicated a hypovolaemic hypotonic hyponatraemia. Serial blood analyses showed an increase in sodium level to 128 mmol/L over the next 24 hours. After 5 days, HIET and adrenaline were stopped. Subsequently, her serum sodium level was normalised. On the following day, she was extubated. However, after 12 days, she died due to sepsis while in the ICU. Pluymers N, et al. Amlodipine overdose presenting with hyponatraemia. Clinical Toxicology 58: 627-628, No. 6, 2020. Available from: URL: http:// doi.org/10.1080/15563650.2020.1741981

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Reactions 26 Sep 2020 No. 1823