Ebihara Takeshi, Morita Masanori, Kawada Masahiro, Amano Koji, Kato Fumitaka, Nakata Yasuki
Department of Critical Care Medical Center Sakai City Medical Center Osaka Japan.
Present address: Sakai City Medical Center on April 1, 2017.
Acute Med Surg. 2017 May 26;4(3):353-357. doi: 10.1002/ams2.284. eCollection 2017 Jul.
Amlodipine predominantly affects vascular smooth muscle cells. Amlodipine overdose usually presents with vasodilatory shock, accompanied by reflex tachycardia rather than bradycardia.An 81-year-old woman presented with impaired consciousness 8 h after ingesting 50 5-mg amlodipine tablets with suicidal intent. On admission, her blood pressure was 50/40 mmHg and her heart rate was 45 b.p.m. Serum amlodipine level was extremely high (474.4 ng/mL), causing refractory bradycardia. She remained hypotensive despite fluid resuscitation, and therefore was administered dopamine and norepinephrine. She was also administered glucagon and calcium gluconate, and underwent high-dose insulin euglycemic therapy.
Although her blood pressure improved, bradycardia progressively worsened and isoproterenol infusion was initiated, which resulted in an improvement in her heart rate. The patient discharged on day 14 without any complications.
Isoproterenol is effective for treating bradycardia after amlodipine overdose.
氨氯地平主要作用于血管平滑肌细胞。氨氯地平过量通常表现为血管扩张性休克，伴有反射性心动过速而非心动过缓。一名81岁女性因有自杀意图服用50片5毫克氨氯地平片后8小时出现意识障碍。入院时，她的血压为50/40 mmHg，心率为45次/分钟。血清氨氯地平水平极高（474.4 ng/mL），导致难治性心动过缓。尽管进行了液体复苏，她仍处于低血压状态，因此给予了多巴胺和去甲肾上腺素。她还接受了胰高血糖素和葡萄糖酸钙治疗，并接受了高剂量胰岛素正常血糖疗法。
尽管她的血压有所改善，但心动过缓逐渐加重，开始静脉输注异丙肾上腺素，这使她的心率得到改善。患者于第14天出院，无任何并发症。
异丙肾上腺素对治疗氨氯地平过量后的心动过缓有效。
