title: Survival of severe amlodipine intoxication due to medical intensive care.
abstract: We report the case of attempted suicide with amlodipine, chlorthalidone and mefenamic acid and subsequent medical intensive care measures which resulted in total recovery of a 42-year-old male. After admission to the medical intensive care unit the intoxicated patient was deeply hypotensive and needed fluid replacement, dobutamine and norepinephrine. Additionally insulin and calcium gluconate were given. Since hypotension persisted and the patient developed oliguria, terlipressin was applied and finally showed an effect on blood pressure and on urinary output. A volume overload of 7 L in the first 24 h resulted in a pulmonary edema. The patient was started on non-invasive ventilation with continuous positive airway pressure (CPAP) and frusemide was added to the therapy with good success. Quantitative determination of amlodipine in plasma samples was performed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The highest amlodipine concentrations was measured in the plasma sample collected approximately 8 h after ingestion of the drug, and was 393 microg/L. Four days later, it was possible to stop the treatment with catecholamines, at that time the amlodipine plasma concentration had declined to 132 microg/L, still tenfold higher than therapeutic (5-18 microg/L). Elimination half-life of amlodipine is approximately 55 h. After 6 days in the intensive care unit the patient was transferred to psychiatric treatment. Intensive care management and plasma levels in this intoxication case are compared to data from literature on other cases.
authors.affiliation: Institute of Forensic Medicine, University Hospital, Freiburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Vogt
authors.forename: Annekathrin
authors.initials: A
authors.lastname: Mehlig
authors.forename: Patrick
authors.initials: P
authors.lastname: Hunziker
authors.forename: André
authors.initials: A
authors.lastname: Scholer
authors.forename: Julia
authors.initials: J
authors.lastname: Jung
authors.forename: Ana Baranda
authors.initials: AB
authors.lastname: González
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Weinmann
authors.forename: Stephan
authors.initials: S
authors.lastname: Marsch
mesh_terms: D000328:Adult; D017311:Amlodipine / Q000009:adverse effects* / Q000097:blood*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D002121:Calcium Channel Blockers / Q000009:adverse effects* / Q000097:blood*; D002752:Chlorthalidone / Q000009:adverse effects; D003422:Critical Care / Q000379:methods*; D004232:Diuretics / Q000009:adverse effects; D062787:Drug Overdose; D005554:Forensic Medicine; D008401:Gas Chromatography-Mass Spectrometry; D006207:Half-Life; D006801:Humans; D008297:Male; D008528:Mefenamic Acid / Q000009:adverse effects; D013406:Suicide, Attempted
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D002121:Calcium Channel Blockers; D004232:Diuretics; D017311:Amlodipine; D008528:Mefenamic Acid; D002752:Chlorthalidone