Document Detail


Amlodipine fatality in an infant with postmortem blood levels.
MedLine Citation:
PMID:  22271567     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Amlodipine is a dihydropyridine calcium channel blocker used in the treatment of hypertension and angina pectoris. Toxic effects reported from amlodipine include hypotension, reflex tachycardia, metabolic acidosis, and pulmonary edema. We report a rare fatality in an infant after ingestion of amlodipine with benazepril, with postmortem blood concentrations.
CASE REPORT: An 11-month-old, 10.88-kg boy ingested 10 to 45 mg amlodipine with 40 to 180 mg benazepril. No action was taken initially because the parents believed only one or two capsules had been ingested. A later count revealed a maximum of nine capsules missing. The child was observed at home and vomited once with possible capsule fragments. Forty-five minutes post-ingestion, the child was noted to be suddenly unresponsive and was brought the local emergency department by a private vehicle. Upon arrival (90 min post-ingestion), the child was unresponsive with the following vital signs HR 133 bpm, BP 67/42 mmHg, respiratory rate 40/min, and temperature 97.5°F. Pertinent abnormal laboratory values were HCO(3) 13 mmol/l and glucose 302 mg/dl. The child was placed on oxygen via a non-rebreather mask and was intubated 45 min post-arrival. The patient became progressively bradycardic, and 55 min after arrival, the patient was in asystole with no palpable blood pressure. Resuscitation measures included chest compressions, epinephrine atropine, sodium bicarbonate, and calcium gluconate. Rescue insulin therapy was begun with 4 units IVP followed by 10 units per hour. Resuscitation efforts persisted for 1 h without success. An autopsy revealed pulmonary edema and no gross or microscopic evidence of natural disease. Stomach contents revealed food matter with small white fragments. Analysis of postmortem heart blood showed amlodipine 1,300 ng/ml (therapeutic <20 ng/ml). Benazepril levels were not available.
DISCUSSION: We believe this is the first reported fatality in an infant from amlodipine. While benazepril may have contributed, ACE inhibitors have not been previously associated with rapid cardiovascular collapse.
CONCLUSION: Small doses of amlodipine (0.9 to 4.1 mg/kg) may produce rapid and fatal cardiovascular collapse in an infant.
Authors:
Henry A Spiller; Beth A Milliner; George M Bosse
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Journal of medical toxicology : official journal of the American College of Medical Toxicology     Volume:  8     ISSN:  1937-6995     ISO Abbreviation:  J Med Toxicol     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-06-13     Completed Date:  2012-10-19     Revised Date:  2013-07-31    
Medline Journal Info:
Nlm Unique ID:  101284598     Medline TA:  J Med Toxicol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  179-82     Citation Subset:  IM    
Affiliation:
Kentucky Regional Poison Control Center of Kosair Children's Hospital, Louisville, KY 40232-5070, USA. henry.spiller@nortonhealthcare.org
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MeSH Terms
Descriptor/Qualifier:
Amlodipine / blood,  poisoning*
Calcium Channel Blockers / poisoning*
Drug Overdose
Fatal Outcome
Humans
Infant
Male
Chemical
Reg. No./Substance:
0/Calcium Channel Blockers; 88150-42-9/Amlodipine
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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