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Case Reports
. 2024 Jul 8:25:e943777.
doi: 10.12659/AJCR.943777.

Effective Management of Severe Amlodipine/Atenolol Overdose with Intravenous Calcium, Hyperinsulinemic Euglycemia Therapy, and Continuous Veno-Venous Hemodialysis: A Case Report

Cong Tan Nguyen  1   2 , Van Cuong Bui  1   2 , Ngoc Son Do  1   2 , Thi Huong Giang Bui  1   3 , The Thach Pham  1   2 , Tuan Phong Hoang  1 , Duc Trieu Ho  1   2
Affiliations
Case Reports

Effective Management of Severe Amlodipine/Atenolol Overdose with Intravenous Calcium, Hyperinsulinemic Euglycemia Therapy, and Continuous Veno-Venous Hemodialysis: A Case Report

Cong Tan Nguyen et al. Am J Case Rep. .

Abstract

BACKGROUND Amlodipine, a calcium channel blocker, and atenolol, a beta blocker, are commonly used as a fixed drug combination (FDC) to treat hypertension. Intentional or non-intentional overdose of amlodipine-atenolol results in hypotension and myocardial depression with a high risk of mortality. This report describes a 64-year-old man with an overdose of amlodipine-atenolol, presenting as an emergency with hypotension, bradycardia, and severe metabolic acidosis. He was successfully treated with intravenous calcium chloride infusion, hyperinsulinemia euglycemia therapy (HIE), and continuous veno-venous hemodialysis (CVVHD). CASE REPORT A 64-year-old man was diagnosed with essential hypertension 1 week prior to the admission. He had been prescribed 1 FDC tablet of amlodipine and atenolol (5+50 mg) per day; however, he took 1 table of the FDC per day for 3 days and then took 3-4 tablets each day during the next 4 days. He was brought to the hospital with hypotension, bradycardia, and severe metabolic acidosis and was diagnosed with amlodipine-atenolol overdose. He was treated with intravenous calcium chloride infusion, HIE, and CVVHD. His hemodynamics started to improve after administering these therapies for 6 h. Inotropes were gradually tapered off and stopped. He was extubated on day 5 and recovered completely. CONCLUSIONS This report shows the serious effects amlodipine-atenolol overdose and the challenges of emergency patient management. An overdose of FDC of amlodipine and atenolol can cause cardiovascular collapse and severe metabolic acidosis. Timely and aggressive management with intravenous calcium infusion, HIE, and CVVHD is essential.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1.
Figure 1.
Chest radiograph on admission suggested pulmonary edema.
Figure 2.
Figure 2.
ECG on admission showed sinus bradycardia with junctional escape beats.
Figure 3.
Figure 3.
Chest radiograph on day 2 showed improvement of pulmonary edema.
Figure 4.
Figure 4.
ECG on day 2 showed the return to sinus rhythm.
See this image and copyright information in PMC

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