Kentucky Regional Poison Control Center of Kosair Children's Hospital, Louisville, KY 40232-5070, USA.
J Med Toxicol. 2012 Jun;8(2):179-82. doi: 10.1007/s13181-011-0207-x.
Amlodipine is a dihydropyridine calcium channel blocker used in the treatment of hypertension and angina pectoris. Toxic effects reported from amlodipine include hypotension, reflex tachycardia, metabolic acidosis, and pulmonary edema. We report a rare fatality in an infant after ingestion of amlodipine with benazepril, with postmortem blood concentrations.
An 11-month-old, 10.88-kg boy ingested 10 to 45 mg amlodipine with 40 to 180 mg benazepril. No action was taken initially because the parents believed only one or two capsules had been ingested. A later count revealed a maximum of nine capsules missing. The child was observed at home and vomited once with possible capsule fragments. Forty-five minutes post-ingestion, the child was noted to be suddenly unresponsive and was brought the local emergency department by a private vehicle. Upon arrival (90 min post-ingestion), the child was unresponsive with the following vital signs HR 133 bpm, BP 67/42 mmHg, respiratory rate 40/min, and temperature 97.5°F. Pertinent abnormal laboratory values were HCO(3) 13 mmol/l and glucose 302 mg/dl. The child was placed on oxygen via a non-rebreather mask and was intubated 45 min post-arrival. The patient became progressively bradycardic, and 55 min after arrival, the patient was in asystole with no palpable blood pressure. Resuscitation measures included chest compressions, epinephrine atropine, sodium bicarbonate, and calcium gluconate. Rescue insulin therapy was begun with 4 units IVP followed by 10 units per hour. Resuscitation efforts persisted for 1 h without success. An autopsy revealed pulmonary edema and no gross or microscopic evidence of natural disease. Stomach contents revealed food matter with small white fragments. Analysis of postmortem heart blood showed amlodipine 1,300 ng/ml (therapeutic <20 ng/ml). Benazepril levels were not available.
We believe this is the first reported fatality in an infant from amlodipine. While benazepril may have contributed, ACE inhibitors have not been previously associated with rapid cardiovascular collapse.
Small doses of amlodipine (0.9 to 4.1 mg/kg) may produce rapid and fatal cardiovascular collapse in an infant.
氨氯地平是一种二氢吡啶类钙通道阻滞剂，用于治疗高血压和心绞痛。氨氯地平的毒性作用包括低血压、反射性心动过速、代谢性酸中毒和肺水肿。我们报告了一例婴儿摄入氨氯地平贝那普利后罕见的死亡病例，并进行了尸检血液浓度检测。
一名 11 个月大、体重 10.88 公斤的男孩摄入了 10 至 45 毫克的氨氯地平，以及 40 至 180 毫克的贝那普利。最初没有采取任何行动，因为父母认为只摄入了一到两个胶囊。后来的计数显示，有多达 9 个胶囊不见了。孩子在家里被观察到，呕吐了一次，可能有胶囊碎片。摄入后 45 分钟，孩子突然失去反应，由私人车辆送往当地急诊室。到达（摄入后 90 分钟）时，孩子没有反应，心率 133 次/分，血压 67/42mmHg，呼吸频率 40/分，体温 97.5°F。相关的异常实验室值为 HCO(3)13mmol/l 和血糖 302mg/dl。孩子通过非再呼吸面罩吸氧，并在到达后 45 分钟内进行插管。患儿逐渐出现心动过缓，到达后 55 分钟时，患儿出现心搏停止，无可触及的血压。复苏措施包括胸外按压、肾上腺素、阿托品、碳酸氢钠和葡萄糖酸钙。开始进行胰岛素抢救治疗，静脉推注 4 单位，随后每小时 10 单位。复苏努力持续了 1 小时，但没有成功。尸检显示肺水肿，无明显的自然疾病的大体或显微镜证据。胃内容物显示有食物残渣和小的白色碎片。死后心脏血液分析显示氨氯地平 1300ng/ml（治疗范围<20ng/ml）。贝那普利的水平不可用。
我们认为这是首例婴儿因氨氯地平而死亡的报告。虽然贝那普利可能有一定的作用，但 ACE 抑制剂以前与心血管迅速崩溃无关。
婴儿摄入小剂量的氨氯地平（0.9 至 4.1mg/kg）可能会导致快速和致命的心血管崩溃。
