Amlodipine/metoprolol succinate overdose
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Various toxicities: case report A 23-year-old woman developed drug toxicity manifested as sinus bradycardia, cardiogenic shock, acute hypoxemic respiratory failure, anuria, drowsiness, lactic acidosis and multi-organ dysfunction syndrome (MODS) following overdose of amlodipine and metoprolol succinate* . The woman was presented to the emergency department (ED) by her family. On ED arrival, her HR was 54, BP 80/40 and SpO2 96% on room air. She had sinus bradycardia and was oriented and followed commands. She reported ingestion of 60 tablets of amlodipine 5mg and metoprolol succinate 50mg each [times to reactions onsets not stated]. The woman underwent gastric lavage along with initiation of dopamine, glucagon, insulin and calcium. During the ICU admission, her arterial BP was continuously monitored. Central venous access was secured. Point of care ultrasound (POCUS) showed ejection fraction of 45% with B-Lines. Afterwards, norepinephrine [noradrenaline] and epinephrine [adrenaline] were initiated for cardiogenic shock. On admission, she was oliguric which progressed to anuria around six hours following the ED arrival. She developed acute hypoxemic respiratory failure. The findings were consistent with MODS. She initially received bilevel positive airway pressure (BiPAP) followed by intubated when she became drowsy. She was initiated on femoro-femoral veno-arterial extracorporeal membrane oxygenation (VA- ECMO) following cardiac consultation. She had profuse diuresis with improvement in oxygenation status and lactic acidosis resolution following the initiation of ECMO. Her circulatory support was weaned with decannulation of ECMO 69 hours after the initiation. She was also extubated the following day. * "Country of occurrence, reporter country and primary source country not stated. Unable to contact author. Abstract presented at CHEST 2020 Annual Meeting on 18-21 October 2020." Rajagopalan R, et al. VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION IN REFRACTORY CARDIOGENIC SHOCK DUE TO COMBINED sBLOCKER AND CALCIUM CHANNEL BLOCKER TOXICITY: A CASE REPORT. Chest 158 (Suppl.): A398 (plus poster), No. 4, 12 Oct 2020. Available from: URL: 803511189 http://doi.org/10.1016/j.chest.2020.08.389
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Reactions 31 Oct 2020 No. 1828
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