| Iatrogenic lipid emulsion overdose in a case of amlodipine poisoning. | |
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MedLine Citation:
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PMID: 20367501 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: Intralipid therapy has been used successfully as "rescue therapy" in several cases of overdose. We present a case of iatrogenic lipid emulsion overdose because of a dosing error. CASE REPORT: A 71-year-old female overdosed on 27 tablets of 5 mg amlodipine. Although initially stable in the Emergency Department, she became hypotensive, oliguric, and respiratory failure developed despite medical therapy. The primary treating team felt that meaningful recovery was unlikely to occur without rapid improvement in clinical status, and 12.5 h after presentation, intralipid rescue therapy was initiated. A protocol for intralipid specifying a maximum infusion of 400 mL of 20% lipid emulsion was faxed, but the infusion was continued until 2 L of lipid emulsion was infused. There were no detectable adverse hemodynamic effects of the intralipid infusion. After this time, laboratory values were difficult to obtain. Three hours after the infusion, a metabolic panel was obtained from ultracentrifuged blood showing hyponatremia. A white blood cell (WBC) was obtained from a complete blood count (CBC) performed 22 h after the infusion, hemoglobin and hematocrit could not be obtained from this blood. A platelet count was obtained by smear estimate. Hematocrits were obtained from centrifuged blood and appeared elevated. No oxygenation could be obtained on blood gas. The patient's family chose to withdraw care on hospital day 2 and no further laboratory draws were obtained. Amlodipine was 1,500 ng/mL (ref. 3-11 ng/mL). DISCUSSION: Lipid emulsion overdose caused no detectable acute adverse hemodynamic effects. The following laboratory values were unobtainable immediately after infusion: white blood cell count, hemoglobin, hematocrit, platelet count, and a metabolic panel of serum electrolytes. Ultracentrifugation of blood allowed for detection of a metabolic panel 3 h after the infusion. Centrifuged hematocrits appeared to be higher than expected. |
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Authors:
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Patrick L West; Nathanael J McKeown; Robert G Hendrickson |
Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Clinical toxicology (Philadelphia, Pa.) Volume: 48 ISSN: 1556-9519 ISO Abbreviation: Clin Toxicol (Phila) Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-05-28 Completed Date: 2010-06-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101241654 Medline TA: Clin Toxicol (Phila) Country: England |
Other Details:
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Languages: eng Pagination: 393-6 Citation Subset: AIM; IM |
Affiliation:
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Department of Emergency Medicine, Kaiser Sunnyside Medical Center, Oregon Health and Science University, Portland, 97239, USA. westp@ohsu.edu <westp@ohsu.edu> |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Amlodipine / poisoning* Antihypertensive Agents / poisoning* Fat Emulsions, Intravenous / administration & dosage, poisoning*, therapeutic use Female Humans Iatrogenic Disease* Medical Errors / adverse effects* Poisoning / drug therapy |
| Chemical | |
Reg. No./Substance:
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0/Antihypertensive Agents; 0/Fat Emulsions, Intravenous; 88150-42-9/Amlodipine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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