Amlodipine/zolpidem overdose
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Refractory vasodilatory shock: case report A 58-year-old woman developed refractory vasodilatory shock following an overdose of amlodipine and zolpidem. The woman presented to an emergency department after an overdose of amlodipine and zolpidem in unknown amounts [routes not stated]. Her vital signs on presentation were normal but deteriorated on arrival [time to reaction onset not stated]; her systolic BP decreased to 85mm Hg and her HR decreased to 50 beats/min. The woman began receiving high-dose insulin and IV calcium gluconate. Because of persistent hypotension, she received dopamine (which was later switched to epinephrine [adrenaline] because of episodes of atrial fibrillation), vasopressin, norepinephrine [noradrenaline] and phenylephrine. However, despite maximum catecholamine doses, her BP was 60/35mm Hg and her HR was 40-50 beats/min. Her serum lactate level was 8.4 mmol/L. An echocardiogram showed an ejection fraction of greater than 90% and she had peripheral vasodilation. Because of continued deterioration, a percutaneous left ventricular assist device (LVAD) was inserted; it remained in place for 11 hours. Catecholamines were weaned over this period and her mean arterial pressure improved to 74 mmHg in 2 hours. A minor arterial tear occurred during removal of the LVAD but it was successfully repaired. After removal of the LVAD, her insulin and vasopressors were weaned and were stopped over the following 12 hours. She recovered with no neurological sequelae. Author comment: "Percutaneous left ventricular assist device may help in poison-induced vasodilatory shock refractory to vasopressors." Laes J, et al. Use of percutaneous left ventricular assist device (impella) in vasodilatory poison-induced shock Clinical Toxicology 51: 673 abstr. 216, No. 7, Aug 2013. Available from: URL: http://informahealthcare.com/doi/ 803095774 abs/10.3109/15563650.2013.817658 - USA
0114-9954/13/1478-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
Reactions 16 Nov 2013 No. 1478
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