title: [Case of olmesartan and amlodipine intoxication].
abstract: Although angiotensin II receptor blocker (ARB) is one of the most common drugs for hypertension in Japan, there are few reports of ARB intoxication. We report a case of persistent hypotension caused by intoxication of olmesartan and amlodipine. A 55-year-old female was transferred to our emergency center 4 hours after taking 180 mg of olmesartan and 140 mg of amlodipine. Continuous hypotension occurred after admission. We used norepinephrine up to 0.33 microg/kg/min to keep her systolic blood pressure > 80 mmHg. We also used calcium gluconate as a treatment for amlodipine intoxication. Although it is predicted the abnormality of electrolyte balance, acid-base balance and renal dysfunction, she had recovered with no remarkable disability. With stabilization of her circulation, we reduced the dose of norepinephrine and stopped it on day 3, and she is discharged on day 5. Her serum olmesartan level was 3,980 ng/mL (normal C(max): 273.5 ng/mL), and serum amlodipine level was 104.9 ng/mL (normal C(max): 2.51 ng/mL). We suggest that it is important to stabilize vital sign to treat ARB intoxication as same as other drug intoxication.
authors.affiliation: Critical Care Medical Center, Japanese Red Cross Shizuoka Hospital.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ideno
authors.forename: Takuro
authors.initials: T
authors.lastname: Nakada
authors.forename: Takako
authors.initials: T
authors.lastname: Oiwa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kobari
authors.forename: Arino
authors.initials: A
authors.lastname: Yaguchi
mesh_terms: D000137:Acid-Base Imbalance / Q000139:chemically induced; D017311:Amlodipine / Q000506:poisoning*; D057912:Angiotensin II Type 2 Receptor Blockers / Q000506:poisoning*; D002125:Calcium Gluconate / Q000008:administration & dosage; D062787:Drug Overdose; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000188:drug therapy*; D007093:Imidazoles / Q000506:poisoning*; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage; D013777:Tetrazoles / Q000506:poisoning*; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000139:chemically induced
chemical_list: D057912:Angiotensin II Type 2 Receptor Blockers; D007093:Imidazoles; D013777:Tetrazoles; D017311:Amlodipine; C437965:olmesartan; D002125:Calcium Gluconate; D009638:Norepinephrine