Amlodipine/atenolol/thioridazine overdose
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Refractory vasodilatory shock in an elderly patient: case report A 69-year-old woman developed refractory vasodilatory shock after an overdose of amlodipine, atenolol and thioridazine. The woman, who had a history of depression and hypertension, presented to an emergency department complaining of lethargy after ingesting unknown quantities of amlodipine, atenolol and thioridazine [time to reaction onset not stated]. Initially, her vital signs were as follows: BP 135/62mm Hg, HR 50 bpm and respiratory rate 18 breaths/min. After 1 hour, her BP fell to 67/40mm Hg, and her pulse rate dropped to 44 beats/min. An ECG revealed sinus bradycardia with normal QT, QRS and PR intervals. The woman was given IV fluids, calcium chloride and glucagon with no improvement. She remained hypotensive despite maximum doses of dopamine, norepinephrine [noradrenaline] and vasopressin. She was administered methylene blue, with a subsequent rise in her systolic BP to 100mm Hg, and an increase in her pulse rate to 70 beats/min. Two further infusions of methylene blue were given, and her vasopressors were tapered. She recovered without further complications, and was moved to the psychiatric service. Author comment: "We report the successful reversal of refractory drug-induced shock with methylene blue administration". "Methylene blue has been used in other vasodilatory shock states such as sepsis and anaphylaxis". Kim HK, et al. Methylene blue for refractory hypotension in cardiovascular drug overdose. Clinical Toxicology 50: 365 abstr. 348, No. 4, Apr 2012. Available 803095413 from: URL: http://dx.doi.org/10.3109/15563650.2012.669957 - USA
0114-9954/13/1477-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
Reactions 9 Nov 2013 No. 1477
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