Kumar Nishant, Zilbermint Mihail
Department of Internal Medicine, Franciscan Health Olympia Fields, South, Olympia Fields, Illinois.
Department of Medicine, Suburban Hospital, Johns Hopkins Medicine, Bethesda, Maryland.
AACE Clin Case Rep. 2024 Sep 4;10(6):257-260. doi: 10.1016/j.aace.2024.08.010. eCollection 2024 Nov-Dec.
BACKGROUND/OBJECTIVE: Calcium channel blockers, when taken in overdose quantities, can cause hyperglycemia requiring so-called hyperinsulinemic-euglycemic therapy. The objective of this report was to describe a patient with calcium channel blocker toxicity resulting from overdose of amlodipine.
A 74-year-old man presented with a fall and loss of consciousness. Prior to this event, he consumed 88 tablets of amlodipine. Medical history was significant for hypertension, hyperlipidemia, and cerebrovascular accident. His vital signs were heart rate of 51 beats/min, blood pressure of 162/137 mm Hg, oxygen saturation of 94% on room air, and respiratory rate of 16 breaths/min. The patient soon became hypotensive. The blood glucose level was 227 mg/dL. Urinalysis was negative for ketones. The patient was diagnosed with calcium channel blocker toxicity and admitted to the intensive care unit. He received continuous insulin infusion and dextrose 25% in water for 5 and 7 days respectively, with a peak insulin infusion rate of 850 U/h. After discontinuation of medications, the glucose level, blood pressure, and heart rate were 82 mg/dL, 127/68 mm Hg, and 86 beats/min, respectively, and he returned to prior functional status.
Amlodipine is a long-acting dihydropyridine class calcium channel blocking drug. In the overdose setting, amlodipine inhibits calcium uptake by myocytes and release of insulin from pancreatic beta cells.
In this case, high-dose insulin euglycemic therapy was effective in the treatment of amlodipine overdose and should be considered in similar cases.
背景/目的：钙通道阻滞剂过量服用时可导致高血糖，需要进行所谓的高胰岛素正常血糖疗法。本报告的目的是描述一名因过量服用氨氯地平导致钙通道阻滞剂中毒的患者。
一名74岁男性因跌倒和意识丧失就诊。在此事件发生前，他服用了88片氨氯地平。病史包括高血压、高脂血症和脑血管意外。他的生命体征为心率51次/分钟、血压162/137毫米汞柱、室内空气下氧饱和度94%、呼吸频率16次/分钟。患者很快出现低血压。血糖水平为227毫克/分升。尿酮体检测为阴性。患者被诊断为钙通道阻滞剂中毒并入住重症监护病房。他分别接受了5天和7天的持续胰岛素输注及25%葡萄糖水输注，胰岛素输注峰值速率为850单位/小时。停药后，血糖水平、血压和心率分别为82毫克/分升、127/68毫米汞柱和86次/分钟，他恢复到之前的功能状态。
氨氯地平是一种长效二氢吡啶类钙通道阻滞剂。在过量服用的情况下，氨氯地平会抑制心肌细胞对钙的摄取以及胰腺β细胞释放胰岛素。
在本病例中，高剂量胰岛素正常血糖疗法对氨氯地平过量服用的治疗有效，在类似病例中应予以考虑。
