Abstract

Combination antihypertensive treatments are usually used in everyday life, which has a life-threatening risk of using an overdose accidentally or suicidally. The effects of calcium channel blockers on the cardiovascular system are negative chronotropic, myocardial depression, decreasing atrioventricular signals, and vasodilatation. Beta blocker drugs are affected to beta receptors of catecholamines with competitively inhibition. Hypotension and bradycardia are the most common cardiac manifestations, and the others are arrhythmias, pulmonary edema, depression of the central nervous system. A previously healthy 4-year-old boy used accidentally 240 mg verapamil/4 mg trandolapril two pieces and 5 mg nebivolol one, at the time of admission his clinical condition was in cardiogenic shock. We successfully treated him with insulin-euglycemia/glucagon treatment, calcium, and lipid infusion therapy, plasmapheresis, and continuous venovenous hemodiafiltration without any sequels. The intoxication of calcium channel blockers and beta blocker drugs are rare but severe cases because of life-threatening.

Keywords: Antihypertensive treatments, calcium channel blocker, beta blocker, cardiogenic shock, intoxication

References

  1. Chrysant SG. Using fixed-dose combination therapies to achieve blood pressure goals. Clin Drug Investig 2008;28:713-34.
  2. Alaygut D, Orbatu D, Oflaz MB. Severe cardiac and renal findings in adolescent girls: Trandolapril/verapamil hydrochloride overdose. Tepecik Eğit. ve Araşt. Hast. Dergisi 2019;29:302-6.
  3. Kolcz J, Pietrzyk J, Januszewska K, Procelewska M, Mroczek T, Malec E. Extracorporeal life support in severe propranolol and verapamil intoxication. J Intensive Care Med 2007;22:381-5.
  4. DeWitt CR, Waksman JC. Pharmacology, pathophysiology and management of calcium channel blocker and beta-blocker toxicity. Toxicol Rev 2004;23:223-38.
  5. Konca Ç, Yıldızdaş RD, Sarı MY, Yükselmiş U, Horoz ÖÖ, Yılmaz HL. Evaluation of poisoned children with calcium channel blockers or beta blockers drugs. Turk Arch Pediatr 2013;48:138-44.
  6. Doğan M, Basaranoglu M, Peker E, Akbayram S, Sahin M, Uner A, et al. Tarka® overdose in a young child. Hum Exp Toxicol 2011;30:1392-8.
  7. Graudins A, Lee HM, Druda D. Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies. Br J Clin Pharmacol 2016;81:453-61.
  8. Durak F, Can FK, Zengin N, Durak İ, Yıldız K, Anıl AB. Successful intravenous lipid infusion therapy in a case with life-threatening calcium channel and beta blockers overdose. J Pediatr Emerg Intensive Care Med 2016;3:151-4.
  9. Kerns W 2nd. Management of beta-adrenergic blocker and calcium channel antagonist toxicity. Emerg Med Clin North Am 2007;25:309-31; abstract viii.
  10. Özen E, Ekemen S, Şen E, Akcan A, Büyükkıdan B. Evaluation of the effectiveness of plasmapheresis in intoxicated patients followed up in intensive care unit. Tepecik Eğit. Araş. Hast. Dergisi 2018;28:111-5.

Copyright and license

Copyright © 2022 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
Arı HF, Eren F, Besin D, Altun İ. The Cardiogenic Shock with Antihypertensive Drugs Intoxication in a Child. Turk J Intensive Care. 2022;20(3):161-164. https://doi.org/10.4274/tybd.galenos.2022.68442