Yeungnam Univ J Med.  2015 Jun;32(1):17-21. 10.12701/yujm.2015.32.1.17.

Amlodipine intoxication complicated by acute kidney injury and rhabdomyolysis

• Lee IH
• Kang GW

• KMID: 2138637
• DOI: http://doi.org/10.12701/yujm.2015.32.1.17

Abstract

Amlodipine, a calcium channel blocker of the dihydropyridine group, is commonly used in management of hypertension, angina, and myocardial infarction. Amlodipine overdose, characterized by severe hypotension, arrythmias, and pulmonary edema, has seldom been reported in Korean literature. We report on a fatal case of amlodipine intoxication with complications including rhabdomyolysis and oliguric acute kidney injury. A 70-year-old woman with a medical history of hypertension was presented at the author's hospital 6 hours after ingestion of 50 amlodipine (norvasc) tablets (total dosage 250 mg) in an attempted suicide. Her laboratory tests showed a serum creatinine level of 2.5 mg/dL, with elevated serum creatine phosphokinase and myoglobin. The patient was initially treated with fluids, alkali, calcium gluconate, glucagon, and vasopressors without a hemodynamic effect. High-dose insulin therapy was also started with a bolus injection of regular insulin (RI), followed by continuous infusion of RI and 50% dextrose with water. Despite intensive treatment including insulin therapy, inotropics, mechanical ventilation, and continuous venovenous hemodiafiltration, the patient died of refractory shock and cardiac arrest with no signs of renal recovery 116 hours after her hospital admission.

Keyword

Amlodipine; Calcium channel blocker; Intoxication; Rhabdomyolysis; Acute kidney injury

MeSH Terms

Acute Kidney Injury*
Aged
Alkalies
Amlodipine*
Arrhythmias, Cardiac
Calcium Channels
Calcium Gluconate
Creatine Kinase
Creatinine
Eating
Female
Glucagon
Glucose
Heart Arrest
Hemodiafiltration
Hemodynamics
Humans
Hypertension
Hypotension
Insulin
Myocardial Infarction
Myoglobin
Pulmonary Edema
Respiration, Artificial
Rhabdomyolysis*
Shock
Suicide, Attempted
Tablets
Water
Alkalies
Amlodipine
Calcium Channels
Calcium Gluconate
Creatine Kinase
Creatinine
Glucagon
Glucose
Insulin
Myoglobin
Tablets
Water