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Connor-Schuler RL, Carr JM, Reaven MS, et al. The Efficacy of Albumin Dialysis in the Reversal of Refractory Vasoplegic Shock Due to Amlodipine Toxicity. Crit Care Explor. 2020;2(6):e0120doi: 10.1097/CCE.0000000000000120.
Connor-Schuler, R. L., Carr, J. M., Reaven, M. S., Bridgman, B. T., Patel, D. M., & Subramanian, R. M. (2020). The Efficacy of Albumin Dialysis in the Reversal of Refractory Vasoplegic Shock Due to Amlodipine Toxicity. Critical care explorations, 2(6), e0120. https://doi.org/10.1097/CCE.0000000000000120
Connor-Schuler, Randi L, et al. "The Efficacy of Albumin Dialysis in the Reversal of Refractory Vasoplegic Shock Due to Amlodipine Toxicity." Critical care explorations vol. 2,6 (2020): e0120. doi: https://doi.org/10.1097/CCE.0000000000000120
Connor-Schuler RL, Carr JM, Reaven MS, Bridgman BT, Patel DM, Subramanian RM. The Efficacy of Albumin Dialysis in the Reversal of Refractory Vasoplegic Shock Due to Amlodipine Toxicity. Crit Care Explor. 2020 Jun 05;2(6):e0120. doi: 10.1097/CCE.0000000000000120. eCollection 2020 Jun. PMID: 32695989; PMCID: PMC7314353.
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Crit Care Explor. 2020 Jun 05;2(6):e0120. doi: 10.1097/CCE.0000000000000120. eCollection 2020 Jun.

The Efficacy of Albumin Dialysis in the Reversal of Refractory Vasoplegic Shock Due to Amlodipine Toxicity.

Critical care explorations

Randi L Connor-Schuler, Jennifer M Carr, Matthew S Reaven, Bob T Bridgman, Deepa M Patel, Ram M Subramanian

Affiliations

  1. Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA.
  2. Emory Center for Critical Care, Emory University, Atlanta, GA.

PMID: 32695989 PMCID: PMC7314353 DOI: 10.1097/CCE.0000000000000120

Abstract

OBJECTIVES: Calcium channel blockers are highly protein-bound medications frequently used in the management of hypertension. Overdose results in severe hypotension and is the fourth most common cause of toxicity-related deaths in the United States. Management is mostly supportive, with currently no standard role for targeted drug removal. The protein-bound nature of these medications presents the option of utilizing albumin dialysis for their removal and for the reversal of associated shock.

DESIGN AND SUBJECTS: We present two cases of life-threatening intentional amlodipine overdoses successfully treated with albumin dialysis. Both patients experienced profound distributive shock in the setting of preserved cardiac contractility that was refractory to maximal vasoactive agent support.

INTERVENTIONS AND RESULTS: After initiation of albumin dialysis, the patients showed rapid hemodynamic improvement and were able to be weaned off vasopressor support.

CONCLUSIONS: These cases demonstrate the safety and efficacy of albumin dialysis in the management of near-fatal calcium channel blocker overdoses related to amlodipine and offer an additional therapeutic option apart from conventional supportive care. Importantly, these cases were not associated with impaired cardiac contractility, thereby making venoarterial extracorporeal membrane oxygenation a less preferable option. Furthermore, this therapeutic benefit of albumin dialysis can potentially be extended to the management of toxicity related to other highly protein-bound drugs and toxins.

Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.

Keywords: albumin dialysis; amlodipine; calcium channel blocker; continuous renal replacement therapy; toxicology; vasoplegia

Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

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