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首页> 外文期刊>Clinical toxicology: the official journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists >Mixed amlodipine/valsartan overdose treated by the molecular adsorbent recirculating system (MARS (TM))
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Mixed amlodipine/valsartan overdose treated by the molecular adsorbent recirculating system (MARS (TM))

机译：通过分子吸附剂再循环系统（MARS（TM））处理的氨氯地平/缬沙坦混合过量

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摘要

Case report. We describe the case of a 58-year-old woman who developed a severe distributive shock following the intentional ingestion of a large overdose of amlodipine (480 mg) combined with valsartan (3680 mg). Extreme vasoplegia remained refractory to maximal standard therapy including fluid resuscitation, intravenous calcium, vasopressors at very high doses, hyperinsulinemia-euglycemia therapy, lipid emulsion, and methylene blue administration. Besides, the patient exhibited hyperglycemia refractory to very high doses of insulin. Due to its theoretical ability to effectively remove protein-bound drugs such as amlodipine from the circulation, albumin dialysis with the molecular adsorbent recirculating system (MARS (TM)) was performed during two consecutive sessions. Blood was drawn for toxicokinetic calculations. Amlodipine elimination half-life during the first MARS (TM) session was calculated at 7.6 h. In addition, there was a rapid fall in blood glucose, requiring the introduction of a continuous infusion of glucose in order to achieve euglycemia. Moreover, a few hours after the initiation of the MARS (TM) therapy, the hemodynamic status was not significantly modified but a significant tapering of epinephrine infusion was possible, together with a progressive decrease of blood lactate level. However, the need for vasopressors in decreasing doses was present until day 5 post-ingestion. Eventually, the patient fully recovered and was discharged home 8 days after admission. Discussion. The role of the MARS (TM) in the treatment of severe poisoning of calcium channel blockers is still to be defined. We were able to demonstrate a relatively short elimination half-life of amlodipine. A decreased insulin resistance and a reduction of epinephrine infusion were also observed.
机译：案例报告。我们描述了一个有意摄入大量过量氨氯地平（480毫克）和缬沙坦（3680毫克）后发生严重分布性休克的58岁妇女的病例。极端血管痉挛对最大标准疗法（包括液体复苏，静脉内钙剂，高剂量血管升压药，高胰岛素血症-血糖正常疗法，脂质乳剂和亚甲蓝）的治疗仍然无效。此外，患者表现出高剂量胰岛素难以耐受的高血糖症。由于其具有从循环中有效去除与蛋白质结合的药物（如氨氯地平）的理论能力，因此在两个连续的环节中使用分子吸附剂再循环系统（MARS（TM））进行了白蛋白透析。抽取血液进行毒代动力学计算。在第一个MARS（TM）阶段计算氨氯地平消除半衰期为7.6 h。另外，血糖迅速下降，需要引入连续的葡萄糖输注以达到正常血糖。此外，在开始MARS（TM）治疗后数小时，血流动力学状态没有明显改变，但肾上腺素输注量可能显着下降，同时血液乳酸水平逐渐降低。但是，直到摄入后第5天，才需要降低剂量的升压药。最终，患者完全康复，入院后8天出院。讨论。 MARS（TM）在严重的钙通道阻滞剂中毒治疗中的作用尚待确定。我们能够证明氨氯地平消除半衰期相对较短。还观察到胰岛素抵抗降低和肾上腺素输注减少。

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