Post Your Cases > LIPID RESCUE THERAPY in an Intoxication with Amlodipin and Valsartan
Objective: to report a case of unsuccessful LIPID RESCUE THERAPY (LRT) in an intoxication involving amlodipin and candesartan. Case report Patient A.H., 65 yr female, BW 80 kg Patient ingested up to 280 mg amlodipin and 4480 mg valsartan in a mixed preparation, delay to hospital app. 5 h. At admission GCS 3, RR 70/40 and falling, HR 70 bpm, SaO2 75% spontaneously breathing FiO2 0,21. Intubation, CVA, fluids in big amounts, noradrenaline > 2mcg/kg/min after 1h, activated charcoal via gastric tube.. Ongoing hypotonia, metabolic acidosis. Fulfilling our institutional criteria for LRT (life-threatening intoxication present). Start LRT 6h after ingestion (bolus/infusion as described elsewhere, total 700ml of INTRALIPID 20% ®. The presentation of the patient did not change in any aspect during the infusion of lipids except for ongoing deterioration of hemodynamics. Establishing vasopressin, hydrocortisone and fluid resuscitation, the vasopressor doses were significantly reduced after 30 h. Concomitting ARF with CVVHD, pneumonia with prolongued respirator therapy. recovering from ARF after 5 days, extubated after 7 days, discharged from ICU to medical ward after 12 days, hospital survivor. Discussion: No positive effects probably related to LRT were observed. Both amlodipin and valsartan are candidate drugs for LRT judged by their liposolubility (logP 3,72 and 4,38, respectively). A retrospective analysed sample of blood drawn before application of LRT showed significant, toxic levels of amlodipin in the blood phase of the patient. We judge the long delay from ingestion to LRT (6 hours) as possible reason for insufficiency of LRT in this case. No negative effects probably related to LRT were observed.
Case report
Patient A.H., 65 yr female, BW 80 kg
Patient ingested up to 280 mg amlodipin and 4480 mg valsartan in a mixed preparation, delay to hospital app. 5 h.
At admission GCS 3, RR 70/40 and falling, HR 70 bpm, SaO2 75% spontaneously breathing FiO2 0,21.
Intubation, CVA, fluids in big amounts, noradrenaline > 2mcg/kg/min after 1h, activated charcoal via gastric tube..
Ongoing hypotonia, metabolic acidosis. Fulfilling our institutional criteria for LRT (life-threatening intoxication present).
Start LRT 6h after ingestion (bolus/infusion as described elsewhere, total 700ml of INTRALIPID 20% ®.
The presentation of the patient did not change in any aspect during the infusion of lipids except for ongoing deterioration of hemodynamics. Establishing vasopressin, hydrocortisone and fluid resuscitation, the vasopressor doses were significantly reduced after 30 h. Concomitting ARF with CVVHD, pneumonia with prolongued respirator therapy. recovering from ARF after 5 days, extubated after 7 days, discharged from ICU to medical ward after 12 days, hospital survivor.
Discussion:
No positive effects probably related to LRT were observed.
Both amlodipin and valsartan are candidate drugs for LRT judged by their liposolubility (logP 3,72 and 4,38, respectively). A retrospective analysed sample of blood drawn before application of LRT showed significant, toxic levels of amlodipin in the blood phase of the patient.
We judge the long delay from ingestion to LRT (6 hours) as possible reason for insufficiency of LRT in this case.
No negative effects probably related to LRT were observed.