Nifedipine/paracetamol overdose
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Pancreatitis: case report A 23-year-old woman developed acute pancreatitis after taking an overdose of nifedipine and paracetamol [acetaminophen] in a suicide attempt. The woman was admitted to hospital 9 hours after ingesting approximately 300 tablets of slow-release nifedipine 10mg and paracetamol [dosage not stated]. On admission, she was awake but experienced tinnitus, nausea, palpitations, and chest tightness. A physical examination revealed pallor of the skin, cyanosis, tachypnea, tachycardia, severe hypotension and decreased bowel sounds. Sinus tachycardia and a ST-T abnormality was detected by ECG. Laboratory analysis on admission revealed a WBC of 15.4 x 103/L, haematocrit of 31.6%, ESR of 34, amylase blood and urine levels of 570 IU/L and 130 IU/L, respectively, a lipase level of 1699 IU/L, AST of 37 IU/L and ALT of 24 IU/L. Plasma concentrations of nifedipine 36 hours post-ingestion were 509 µg/L, with an estimated peak level of 2000 µg/L (therapeutic range 25 to 100). Paracetamol concentrations 9 hours post-ingestion were 184 µg/mL. Urine amylase levels peaked at 1770 IU/L on the second day of admission, with AST and ALT levels rising to 601 and 427 IU/L, respectively, on the third day. Ultrasound examination of the abdomen revealed an oedematous pancreas with no evidence of gallstones or biliary-tree dilatation or obstruction and an abdominal CT scan showed an inflamed pancreas with no evidence of necrosis. Gastric lavage, activated charcoal, aggressive hydration, calcium chloride, glucagon, and vasopressors were unsuccessfully used to treat the hypotension. She was administered acetylcysteine for paracetamol overdose and was intubated for respiratory distress and altered mental status 24 hours after presentation. She remained hypotensive and oliguric, and was given vasopressors for 48 hours and respiratory support for 4 days. She also received oxygen for 5 days and continuous veno-venous haemodiafiltration was initiated 48 hours after admission, due to renal failure and metabolic acidosis. Her recovery was slowed by sepsis, cytolysis and bilateral pleurisy. Ten days after admission, her mentation and blood tests were normal and she was discharged to an outside rehabilitation facility. Author comment: "[W]e believe that toxic doses of nifedipine are principally responsible for inducing [acute pancreatitis] by severe hypotension." Sorodoc L, et al. Acute pancreatitis after nifedipine and acetaminophen poisoning: case report. Central European Journal of Medicine 4: 527-531, No. 4, Dec 2009 801154983 Romania
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Reactions 9 Jan 2010 No. 1283
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