Vasodilation in patients with calcium channel blocker poisoning treated with high-dose insulin: a comparison of amlodipine versus non-dihydropyridines

Cole, Jon B.; Lee, Samantha C.; Prekker, Matthew E.; Kunzler, Nathan M; Considine, Kelly A; Puskarich, Michael A.; Olives, Travis D.

doi:10.1080/15563650.2022.2131565

Cited by 10 publications

(2 citation statements)

References 59 publications

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“…Vasoplegia is a known complication of sepsis and cardiovascular surgeries and is often seen in critical care settings [3][4]. Amlodipine, an oral dihydropyridine CCB, preferentially inhibits peripheral vascular and coronary calcium influx via slow channels, resulting clinically in decreased vascular tone [4,8]. Toxicity can occur with the unintentional or intentional intake of higher than prescribed doses and is a potential etiology of vasoplegia in patients.…”

Section: Discussionmentioning

confidence: 99%

“…Norepinephrine is the best studied and is the first-line treatment agent. However, evidence suggests that administration of combination therapy of multiple catecholamines with different medications of action, such as the addition of non-catecholamine agents (e.g., methylene blue, hydroxocobalamin), results in greater increases in MAP and a reduction in overall norepinephrine equivalent vasopressor requirements [1,[4][5][8][9][11][12]. Methylene blue reduces NO production via inhibition of iNOS, a rate-limiting step in NO production, as well as inhibition of guanylate cyclase [1].…”

Section: Discussionmentioning

confidence: 99%

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The Use of Methylene Blue in Conjunction With Hydroxocobalamin and Multiple Pressors to Treat Severe Vasoplegia in a Patient Due to Calcium Channel Blocker Toxicity: A Case Report

Hacker,

Irvine,

Gross

et al. 2024

Cureus

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Vasoplegia, the demonstration of persistently low systemic vascular resistance (SVR) and resistant hypotension in the presence of a normal cardiac index despite aggressive resuscitation attempts, is a serious clinical diagnosis that requires prompt treatment to prevent patient morbidity and mortality. Currently, treatment of vasoplegia involves treatment with vasopressors such as vasopressin, norepinephrine, and hydroxocobalamin. However, some evidence suggests that in addition to this treatment regimen, the addition of methylene blue may result in a reduction in overall norepinephrine equivalent vasopressor requirements, increased mean arterial pressure, and an improved clinical course. Here, we report the case of a 64-year-old male patient who presented to the ED after being found unresponsive and covered in emesis at home. The patient's presentation was complicated by worsening dyspnea, hypotension, and hemodynamic instability, requiring intubation and admission to the ICU for management of undifferentiated shock of unclear etiology and acute respiratory failure. Urine studies were consistent with a diagnosis of vasoplegia due to dihydropyridine calcium channel blocker toxicity, which was confirmed by pill counting of his home medications in the setting of recent paranoia and depression. The patient was treated aggressively with vasopressors, including vasopressin, phenylephrine, and epinephrine, as well as a combination of hydroxocobalamin and methylene blue. He was also started on a calcium and insulin drip. Upon initiation of non-catecholamine agents for vasoplegia, his clinical course quickly improved, and he was weaned from all vasopressors. He regained hemodynamic stability, was successfully extubated, evaluated by psychiatry, and discharged from the hospital in a stable condition on day 15 with the continuation of outpatient psychiatric services.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Use of Methylene Blue in Conjunction With Hydroxocobalamin and Multiple Pressors to Treat Severe Vasoplegia in a Patient Due to Calcium Channel Blocker Toxicity: A Case Report

Hacker,

Irvine,

Gross

et al. 2024

Cureus

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The use of hyperinsulinemia‐euglycaemia therapy in the treatment of amlodipine overdose in a dog

Ellis,

Odunayo

2024

Vet Record Case Reports

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A 1‐year‐old, female, spayed, mixed breed dog presented for lethargy, ataxia and possible ingestion of amlodipine. Based on clinical signs, history and clinicopathological findings, a diagnosis of amlodipine toxicosis was made. The patient's clinical signs and bloodwork derangements were refractory to traditional medical management for calcium channel blocker toxicosis, but a significant improvement was made after initiation of hyperinsulinemia‐euglycaemia therapy. The dog survived and made a full recovery. The use of hyperinsulinemia‐euglycaemia therapy for amlodipine toxicosis has not previously been reported in dogs. Hyperinsulinemia‐euglycaemia therapy can be used for treatment of hypotension as well as other clinical signs associated with calcium channel blocker toxicosis. The use of hyperinsulinemia‐euglycaemia therapy should be considered for amlodipine toxicosis in dogs.

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Methylene Blue–Induced Serotonin Toxicity: Case Files of the Medical Toxicology Fellowship at the New York City Poison Control Center

Hazekamp,

Schmitz,

Scoccimarro

2023

J. Med. Toxicol.

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Vasodilation in patients with calcium channel blocker poisoning treated with high-dose insulin: a comparison of amlodipine versus non-dihydropyridines

Cited by 10 publications

References 59 publications

The Use of Methylene Blue in Conjunction With Hydroxocobalamin and Multiple Pressors to Treat Severe Vasoplegia in a Patient Due to Calcium Channel Blocker Toxicity: A Case Report

The Use of Methylene Blue in Conjunction With Hydroxocobalamin and Multiple Pressors to Treat Severe Vasoplegia in a Patient Due to Calcium Channel Blocker Toxicity: A Case Report

The use of hyperinsulinemia‐euglycaemia therapy in the treatment of amlodipine overdose in a dog

Methylene Blue–Induced Serotonin Toxicity: Case Files of the Medical Toxicology Fellowship at the New York City Poison Control Center

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