scholarly journals Unresponsive shock due to amlodipine overdose: An unexpected cause

2018 ◽  
Vol 10 (4) ◽  
pp. 246-247 ◽  
Author(s):  
Shailesh Kumar ◽  
Devyani Thakur ◽  
Ritesh Kumar Gupta ◽  
Alka Sharma
Keyword(s):  
Channel Blocker ◽  
Kidney Injury ◽  
Poor Performance ◽  
Interesting Case ◽  
Young Lady ◽  
Fluid Replacement ◽  
Refractory Shock ◽  
Shock Reversal ◽  
Dihydropyridine Calcium Channel Blocker ◽  
Hypertensive Drug

Amlodipine is a dihydropyridine calcium channel blocker which is widely used as an anti-hypertensive drug. Amlodipine overdose has been infrequently reported with the occurrence of serious complications and even death in a few cases. We report an interesting case of a young lady who presented with refractory shock with acute kidney injury, which did not respond to therapy despite optimal fluid replacement and vasopressor support. The etiology of shock could not be ascertained and the patient was questioned again to elucidate the missing clue in the history. It was finally revealed that the patient had consumed 900 mg of amlodipine in a suicide bid, for her poor performance in academics. The targeted therapy in the form of IV calcium and hyperinsulinemia-euglycemia therapy (HIET) was started and the patient dramatically improved with shock reversal and improvement in renal function.

scholarly journals Extracorporeal cardiopulmonary resuscitation for the treatment of amlodipine overdose in a pediatric patient

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Katherine Giuliano ◽  
Y Julia Chen ◽  
Kristen Coletti ◽  
Caitlin O’Brien ◽  
Eric Jelin ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Channel Blocker ◽  
Pulseless Electrical Activity ◽  
Kidney Injury ◽  
Intermittent Hemodialysis ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Refractory Shock ◽  
Home Medication ◽  
Unclear Etiology ◽  
Neurologically Intact

Abstract We present the case of a 16-year-old female with systemic lupus erythematosus who presented with shock of unclear etiology, refractory to fluid resuscitation and triple vasopressors. She suffered pulseless electrical activity and underwent cannulation onto veno-arterial extracorporeal membrane oxygenation (ECMO). After cannulation, it was discovered she had intentionally overdosed on her home medication, amlodipine, a calcium channel blocker (CCB). She was supported on ECMO, treated with IV calcium and insulin, and was able to be weaned off ECMO after 4 days. She developed oligoanuric acute kidney injury, treated with continuous renal replacement therapy followed by intermittent hemodialysis. At discharge, she was neurologically intact and did not require dialysis. Herein, we review the treatment of CCB overdose, review the literature on the use of ECMO in refractory shock due to cardiovascular medication overdose, and highlight the utility of ECMO in pediatric refractory shock and/or cardiac arrest of unclear etiology.

scholarly journals Effect of Dihydropyridine Calcium-Channel Blocker on Adverse Aortic Events After Thoracic Endovascular Aortic Repair for Type B Aortic Dissection

2021 ◽  
Author(s):  
Fan Yang ◽  
Lyufan Chen ◽  
Jitao Liu ◽  
Songyuan Luo ◽  
Caiyun He ◽  
...  
Keyword(s):  
Propensity Score ◽  
Aortic Dissection ◽  
Calcium Channel ◽  
Propensity Score Matching ◽  
Calcium Channel Blocker ◽  
Channel Blocker ◽  
Thoracic Endovascular Aortic Repair ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Dihydropyridine Calcium Channel Blocker

Abstract Objectives: This study aimed to evaluate the effect of dihydropyridine calcium-channel blocker (CCB) on adverse aortic events (AAE) in patients undergoing thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). Methods: A retrospective study was conducted on patients undergoing TEVAR of TBAD from January 2010 to December 2017 in our center. Patients were divided into CCB group and non-CCB group according to the postoperative dihydropyridine CCB use. AAE including aorta-relative mortality and reintervention, were compared between these two groups. Propensity score matching analysis was performed to avoid the potential effect of known confounders.Results: Before matching, the study cohort comprised 548 patients, including 435 (79.4%) and 113 (20.6%) patients in the CCB and non-CCB groups, respectively. After matching, 101 patients in each group were eligible for the analysis. In the unmatched cohort, AAE occurred in 52 (12.0%) and 29 (25.7%) patients in the CCB and non-CCB groups, respectively (P < 0.001). In the matched cohort, AAE occurred in 8 (7.9%) and 22 (21.8%) patients in the CCB and non-CCB groups, respectively (P = 0.013). Log-rank test analysis revealed that the levels of freedom from AAE were significantly different between the 2 groups in both the unmatched and matched cohorts (P < 0.001 and P = 0.007, respectively). Multivariable analysis showed that CCB use (hazard ratio 0.50, 95% confidence interval 0.32–0.80; P = 0.003) was associated with a lower AAE rate after adjustment for other variables, and was minimally changed after the propensity score matching (HR 0.34, 95% CI 0.15–0.75; P = 0.008).Conclusions: Postoperative dihydropyridine CCB use is protective in patients undergoing TEVAR for acute and sub-acute TBAD.

scholarly journals Perioperative Acute Kidney Injury

2020 ◽  
Vol 132 (1) ◽  
pp. 180-204 ◽  
Author(s):  
Sam D. Gumbert ◽  
Felix Kork ◽  
Maisie L. Jackson ◽  
Naveen Vanga ◽  
Semhar J. Ghebremichael ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Fluid Replacement ◽  
Organ Injury ◽  
Surgical Patients ◽  
Creatinine Concentration ◽  
Ongoing Research ◽  
Different Types ◽  
Novel Biomarkers ◽  
Goal Directed Fluid Therapy

Abstract Perioperative organ injury is among the leading causes of morbidity and mortality of surgical patients. Among different types of perioperative organ injury, acute kidney injury occurs particularly frequently and has an exceptionally detrimental effect on surgical outcomes. Currently, acute kidney injury is most commonly diagnosed by assessing increases in serum creatinine concentration or decreased urine output. Recently, novel biomarkers have become a focus of translational research for improving timely detection and prognosis for acute kidney injury. However, specificity and timing of biomarker release continue to present challenges to their integration into existing diagnostic regimens. Despite many clinical trials using various pharmacologic or nonpharmacologic interventions, reliable means to prevent or reverse acute kidney injury are still lacking. Nevertheless, several recent randomized multicenter trials provide new insights into renal replacement strategies, composition of intravenous fluid replacement, goal-directed fluid therapy, or remote ischemic preconditioning in their impact on perioperative acute kidney injury. This review provides an update on the latest progress toward the understanding of disease mechanism, diagnosis, and managing perioperative acute kidney injury, as well as highlights areas of ongoing research efforts for preventing and treating acute kidney injury in surgical patients.

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