title: Massive Atenolol, Lisinopril, and Chlorthalidone Overdose Treated with Endoscopic Decontamination, Hemodialysis, Impella Percutaneous Left Ventricular Assist Device, and ECMO.
abstract: BACKGROUND
  Overdose of cardiovascular medications is increasingly associated with morbidity and mortality. We present a case of substantial atenolol, chlorthalidone, and lisinopril overdose treated by multiple modalities with an excellent outcome.
  
  
  CONCLUSIONS
  Aggressive medical intervention did not provide sufficient hemodynamic stability in this patient with refractory cardiogenic and distributive shock. Impella® percutaneous left ventricular assist device and extracorporeal membrane oxygenation provided support while the effects of the overdose subsided. We present concentrations demonstrating removal of atenolol with continuous venovenous hemodiafiltration. This is the first report of esophagogastroduo denoscopy decontamination of this overdose with a large pill fragment burden.
authors.affiliation: Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ, USA, craig.heise@bannerhealth.com.
authors.forename: C William
authors.initials: CW
authors.lastname: Heise
authors.forename: David
authors.initials: D
authors.lastname: Beutler
authors.forename: Adam
authors.initials: A
authors.lastname: Bosak
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Orme
authors.forename: Akil
authors.initials: A
authors.lastname: Loli
authors.forename: Kimberlie
authors.initials: K
authors.lastname: Graeme
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000506:poisoning; D000328:Adult; D001262:Atenolol / Q000506:poisoning*; D002317:Cardiovascular Agents / Q000506:poisoning*; D002752:Chlorthalidone / Q000506:poisoning*; D003131:Combined Modality Therapy; D003666:Decontamination; D062787:Drug Overdose / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D004636:Emergency Service, Hospital; D016145:Endoscopy, Digestive System; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D017706:Lisinopril / Q000506:poisoning*; D009102:Multiple Organ Failure / Q000209:etiology; D006435:Renal Dialysis; D012770:Shock, Cardiogenic / Q000209:etiology; D013607:Tablets; D004561:Transcutaneous Electric Nerve Stimulation; D016896:Treatment Outcome
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D002317:Cardiovascular Agents; D013607:Tablets; D001262:Atenolol; D017706:Lisinopril; D002752:Chlorthalidone