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Matsushime S, Kuriyama A. Vasopressin for persistent hypotension due to amlodipine and olmesartan overdose: A case report. Ann Med Surg (Lond). 2021;65:102292doi: 10.1016/j.amsu.2021.102292.
Matsushime, S., & Kuriyama, A. (2021). Vasopressin for persistent hypotension due to amlodipine and olmesartan overdose: A case report. Annals of medicine and surgery (2012), 65102292. https://doi.org/10.1016/j.amsu.2021.102292
Matsushime, Susumu, and Kuriyama, Akira. "Vasopressin for persistent hypotension due to amlodipine and olmesartan overdose: A case report." Annals of medicine and surgery (2012) vol. 65 (2021): 102292. doi: https://doi.org/10.1016/j.amsu.2021.102292
Matsushime S, Kuriyama A. Vasopressin for persistent hypotension due to amlodipine and olmesartan overdose: A case report. Ann Med Surg (Lond). 2021 Apr 15;65:102292. doi: 10.1016/j.amsu.2021.102292. eCollection 2021 May. PMID: 33981424; PMCID: PMC8082198.
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Ann Med Surg (Lond). 2021 Apr 15;65:102292. doi: 10.1016/j.amsu.2021.102292. eCollection 2021 May.

Vasopressin for persistent hypotension due to amlodipine and olmesartan overdose: A case report.

Annals of medicine and surgery (2012)

Susumu Matsushime, Akira Kuriyama

Affiliations

  1. Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa Kurashiki Okayama, 710-8602, Japan.

PMID: 33981424 PMCID: PMC8082198 DOI: 10.1016/j.amsu.2021.102292

Abstract

BACKGROUND: While there are consensus recommendations for managing calcium channel blocker (CCB) toxicity, reports on angiotensin II receptor blocker (ARB) toxicity and management are limited. Herein, we report a case of catecholamine-refractory hypotension due to CCB and ARB overdose.

CASE PRESENTATION: A 54-year-old woman with underlying hypertension was brought to the emergency department after she attempted suicide by ingesting 345 mg of amlodipine, a CCB, and 340 mg of olmesartan, an ARB. She was hypotensive, which was considered vasodilatory because of high cardiac and low systemic vascular resistance indices. Hypotension persisted despite the administration of norepinephrine and epinephrine. Intravenous calcium gluconate, glucagon, and high-dose insulin euglycemia therapy, which were initiated because CCB toxicity was suspected, failed to raise her blood pressure. The presence of normal anion-gap metabolic acidosis and the fact that the patient remained hypotensive suggested that the hypotension might have been due to the effect of ARB. Vasopressin was finally administered, which improved her hemodynamic status. She was weaned off all vasopressors on day 3.

DISCUSSION: There is no consensus recommendation for ARB toxicity. Since chronic use of ARBs at conventional doses can block the sympathetic nervous and renin-angiotensin systems, catecholamines may not effectively increase blood pressure in cases of hypotension due to ARB overdose, for which vasopressin could be indicated.

CONCLUSIONS: Vasopressin could be an option for treating hypotension secondary to ARB and CCB toxicity when catecholamines and treatment for CCB toxicity fail.

© 2021 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

Keywords: ACE, angiotensin-converting enzyme; ARB, angiotensin II receptor blocker; Angiotensin receptor antagonists; CCB, calcium channel blocker; Drug overdose; ED, emergency department; Vasopressins

Conflict of interest statement

The authors declare that they have no conflict of interest.

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