Amlodipine過量引起嚴重低血壓之處置

Management of Amlodipine-Related Severe Hypotension

背景：鈣離子阻斷劑（calcium channel blocker, CCB），目前用於高血壓、心絞痛及心律不整的治療。然而，目前尚無專一的解毒劑，理論上數種治療可用於CCB 過量，如活性炭、鈣鹽、胰島素、升糖激素、脂肪乳化劑、以及正腎上腺素。本文報告吞服大量amlodipine 後產生嚴重低血壓、反射性心搏過快及代謝性酸中毒，使用升壓劑和輸注胰島素來緩解症狀。案例陳述：一名64 歲女性，吞服了百顆amlodipine（5mg/tab）企圖自殺，4 小時後被送至急診，剛入院的臨床表徵：低血壓（69/29 mmHg）、心搏快（103 bpm）、高血糖（263 mg/dL）及代謝性酸中毒（lactate＝4.96 mmol/L，ABG pH＝7.301）等，住院中陸續給予靜脈輸液氯化鈣、正腎上腺素、升糖素與胰島素以維持生命徵象。病人於入院第4 日停止胰島素；入院第5 日血壓得以控制，停用正腎上腺素；另外，在住院期間還發生了尿道感染，在抗生素治療後已改善。入院第14 天允許出院。結論：CCB 中毒可能危及生命，以支持療法維持病人正常的血行動力學是最重要的處置。

Background: Calcium channel blockers (CCBs) are commonly used in the treatment in hypertension, angina and arrhythmia. However, thus far, no specific antidote exists for CCBs overdose. Several treatments are used theoretically for CCB overdose such as activated charcoal, calcium salt, insulin, glucagon, lipid emulsion and norepinephrine. In this article, we report a patient who took a large amount of amlodipine tablets and experienced severe hypotension, tachycardia and metabolic acidosis. We successfully treated her with continuous infusion of high dose insulin and an inotropic agent. Case description: A 64-year-old female committed a suicide attempt by swallowing almost 100 tablets of amlodipine (5mg/tab). She was sent to emergency room 4 hours after swallowing the amlodipine tablets. On presentation, her blood pressure was 69/29 mmHg, heart rate was 103 bpm, blood glucose was 263 mg/dL and lactate was 4.96 mmol/L. Calcium chloride, norepinephrine, glucagon and insulin were used for this patient to maintain her vital signs and to treat her amlodipine intoxication. Insulin infusion and norepinephrine were gradually tapered off at the 4th and 5th day of admission, respectively. In addition, urinary tract infection occurred during hospitalization, she was cured after antibiotics treatment. Patient was then discharged after 14 days of hospitalization. Conclusion: CCB overdose is a life threatening event, and supportive care to maintain hemodynamics is the most important treatment.