title: Refractory hypotension and ECG changes in a case of nicorandil and lisinopril overdose and role of vasopressor in management.
abstract: We present a rare case of a 13-year-old girl who took an intentional mixed overdose of nicorandil, lisinopril and metoclopramide. This is the first reported case in the literature of nicorandil overdose in the paediatric age group. The chief presenting clinical signs were hypoxia, peripheral hypoperfusion and hypotension with tachycardia unresponsive to aggressive intravenous volume expansion. Subsequent ECG changes suggested evolving myocardial ischaemia and were accompanied by complaints of back pain and worsening shortness of breath. Vasopressor therapy led to an immediate resolution of the ECG changes and improved the hypotension. This was continued for a further 24 h, until haemodynamic stability was achieved.
authors.affiliation: Ucon Health Center, Hartford, Connecticut, USA. abhijitghatak@yahoo.com
authors.forename: Abhijit
authors.initials: A
authors.lastname: Ghatak
authors.forename: Martyn
authors.initials: M
authors.lastname: Farrer
mesh_terms: D000293:Adolescent; D000959:Antihypertensive Agents / Q000506:poisoning*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy*; D062787:Drug Overdose; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000188:drug therapy* / Q000503:physiopathology; D017706:Lisinopril / Q000506:poisoning*; D020108:Nicorandil / Q000506:poisoning*; D009638:Norepinephrine / Q000627:therapeutic use; D013406:Suicide, Attempted; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D014662:Vasoconstrictor Agents; D020108:Nicorandil; D017706:Lisinopril; D009638:Norepinephrine