Successful Treatment of Antihypertensive Overdose Using Intravenous Angiotensin II

Carpenter, Joseph; Murray, Brian Patrick; Saghafi, Ramin; Thomas, BO; Lee, Sean; Kleiman, Richard; Punja, Mohan; Silver, Elizabeth; Busse, Laurence W.

doi:10.1016/j.jemermed.2019.05.027

Cited by 10 publications

(2 citation statements)

References 22 publications

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“…Angiotensin II does not typically exhibit chronotropic or inotropic effects [4]. One case series reported direct chronotropic changes, where two patients had an increase in heart rate within 30 min of angiotensin II administration [28]. Busse et al's recent literature review demonstrated the successful use of angiotensin II in patients with shock from various aetiologies including distributive, cardiogenic and haemorrhagic [18].…”

Section: Mean Arterial Pressure Systolic Blood Pressure Heart Rate An...mentioning

confidence: 99%

The Role of Angiotensin II in Poisoning-Induced Shock—a Review

Chen

Wong

2022

J. Med. Toxicol.

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Background Shock in drug poisoning is a life-threatening condition and current management involves fluid resuscitation and vasopressor therapy. Management is limited by the toxicity of high-dose vasopressors such as catecholamines. Clinical trials have shown the efficacy of angiotensin II as an adjunct vasopressor in septic shock. The aim of this review is to assess the use of angiotensin II in patients with shock secondary to drug overdose. Methods Medline (from 1946), Embase (from 1947) and PubMed (from 1946) databases were searched until July 2021 via OVID. Included studies were those with shock due to drug poisoning and received angiotensin II as part of their treatment regimen. Of the 481 articles identified, 13 studies (case reports and scientific abstracts) were included in the final analysis with a total of 14 patients. Extracted data included demographics, overdose drug and dosage, angiotensin II dosage, time of angiotensin II administration, haemodynamic changes, length of hospital stay, mortality, complications, cardiac function and other treatment agents used. Results Thirteen studies were included consisting of 6 case reports, 6 scientific abstracts and 1 case series. Overdose drugs included antihypertensives (n = 8), psychotropics (n = 4), isopropanol (n = 1) and tamsulosin (n = 1). Out of a total of 14 patients, 3 patients died. Ten patients had their haemodynamic changes reported. In terms of MAP or SBP changes, three patients (30%) had an immediate response to angiotensin II, four patients (40%) had responses within 30 min, one patient (10%) within two hours and two patients (20%) did not have their time reported. Two patients were shown to have direct chronotropic effects within 30 min of angiotensin II administration. The median hospital stay for patients was 5 days (IQR = 4). The time from overdose until angiotensin II administration ranged from 5 to 56 h. Other vasopressors used included phenylephrine, noradrenaline, adrenaline, vasopressin, dobutamine, dopamine, methylene blue and ephedrine. A median of 3 vasopressors were used before initiation of angiotensin II. Twelve patients received angiotensin II as their final treatment. Conclusions Angiotensin II may be useful as an adjunct vasopressor in treating shock secondary to drug poisoning. However, the current literature consisted of only very low-quality studies. To truly assess the utility of angiotensin II use in drug-induced poisoned patients, further well-designed prospective studies are required.

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Section: Mean Arterial Pressure Systolic Blood Pressure Heart Rate An...mentioning

confidence: 99%

The Role of Angiotensin II in Poisoning-Induced Shock—a Review

Chen

Wong

2022

J. Med. Toxicol.

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“…69 Future research studies on this population will help further examine the effect of Ang-2 on the hemodynamics of patients taking ACE-Is presenting in shock. 83,84 In addition, patients with pulmonary pathology such as those with severe pneumonia, acute respiratory distress syndrome, or those on veno-veno extracorporeal membrane circulation may have impaired ACE function, resulting in a deficiency of Ang-2. Likewise, when patients in these populations develop septic shock, they may uniquely benefit from the targeted administration of exogenous Ang-2, but this avenue requires more research.…”

Section: Future Areas Of Researchmentioning

confidence: 99%

Angiotensin II and Vasopressin for Vasodilatory Shock: A Critical Appraisal of Catecholamine-Sparing Strategies

Heavner

McCurdy

Mazzeffi

et al. 2020

J Intensive Care Med

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Vasodilatory shock is a serious medical condition that increases the morbidity and mortality of perioperative and critically ill patients. Norepinephrine is an established first-line therapy for this condition, but at high doses, it may lead to diminishing returns. Oftentimes, secondary noncatecholamine agents are required in those whose hypotension persists. Angiotensin II and vasopressin are both noncatecholamine agents available for the treatment of hypotension in vasodilatory shock. They have distinct modes of action and unique pharmacologic properties when compared to norepinephrine. Angiotensin II and vasopressin have shown promise in certain subsets of the population, such as those with acute kidney injury, high Acute Physiology and Chronic Health Evaluation II scores, or those receiving cardiac surgery. Any benefit from these drugs must be weighed against the risks, as overall mortality has not been shown to decrease mortality in the general population. The aims of this narrative review are to provide insight into the historical use of noncatecholamine vasopressors and to compare and contrast their unique modes of action, physiologic rationale for administration, efficacy, and safety profiles.

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Multiple drug overdose

2019

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Successful Treatment of Antihypertensive Overdose Using Intravenous Angiotensin II

Cited by 10 publications

References 22 publications

The Role of Angiotensin II in Poisoning-Induced Shock—a Review

The Role of Angiotensin II in Poisoning-Induced Shock—a Review

Angiotensin II and Vasopressin for Vasodilatory Shock: A Critical Appraisal of Catecholamine-Sparing Strategies

Multiple drug overdose

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