Tale Sudheer, Kumar Mohan, Ghosh Soumitra, Bhalla Ashish
Department of Internal medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Crit Care Med. 2019 Jun;23(6):281-283. doi: 10.5005/jp-journals-10071-23181.
Treating a patient of amlodipine-atenolol poisoning is nightmare for a physician. In high dose both the drugs individually cause severe bradycardia and hypotension. In combination they cause severe cardiovascular depression. Here we report a case of 66-year-old obese, hypertensive, depressed male, who presented to emergency 9 hours after consumption of 25 tablets of amlodipine-atenolol (5 mg+50 mg). On evaluation, he had refractory bradycardia, hypotension and acute kidney injury (AKI). Eventually he developed cardiac arrest. He was revived after 5 minutes of cardio-pulmonary resuscitation (CPR). He was successfully managed with gastric lavage, fluids, inotropes, atropine, isoprenaline and subsequently with calcium gluconate infusion, high-dose insulin euglycemia therapy (HIET) and lipid emulsion therapy. Glucagon infusion was also planned but it was not available. Patient hemodynamics improved and on 8th day he got the discharge. Our case exemplifies the importance of timely and aggressive management of lethal overdose of amlodipine-atenolol poisoning. Tale S, Kumar M, Ghosh S, Bhalla A. A Case of Life-threatening Amlodipine and Atenolol Overdose. Indian J Crit Care Med 2019;23(6):281-283.
对于医生来说，治疗氨氯地平-阿替洛尔中毒患者是一场噩梦。这两种药物大剂量单独使用时都会导致严重的心动过缓和低血压。联合使用时会引起严重的心血管抑制。在此，我们报告一例66岁肥胖、高血压、抑郁男性患者，在服用25片氨氯地平-阿替洛尔（5毫克+50毫克）9小时后就诊于急诊科。经评估，他出现难治性心动过缓、低血压和急性肾损伤（AKI）。最终他发生了心脏骤停。在进行5分钟心肺复苏（CPR）后他恢复了心跳。通过洗胃、补液、使用血管活性药物、阿托品、异丙肾上腺素，随后输注葡萄糖酸钙、高剂量胰岛素正常血糖疗法（HIET）和脂质乳剂疗法，他得到了成功救治。也曾计划输注胰高血糖素，但未获得。患者的血流动力学状况得到改善，并于第8天出院。我们的病例例证了对氨氯地平-阿替洛尔中毒致死性过量进行及时、积极治疗的重要性。 塔莱S、库马尔M、戈什S、巴拉拉A。一例危及生命的氨氯地平和阿替洛尔过量病例。《印度重症监护医学杂志》2019年；23(6):281 - 283。
