RESUMO
Overdose with calcium channel blockers is uncommon, but is associated with high mortality. The management includes fluid resuscitation, calcium gluconate, glucagon, vasopressors, and high-dose insulin-euglycemia therapy. We describe a rare case of massive overdose of lercanidipine with shock, refractory to conventional therapies and multi-organ failure. Charcoal hemoperfusion with continuous venovenous hemodiafiltration was then used successfully and the patient showed remarkable recovery.
Assuntos
Anlodipino/intoxicação , Anti-Hipertensivos/intoxicação , Bloqueadores dos Canais de Cálcio/intoxicação , Carvão Vegetal/uso terapêutico , Di-Hidropiridinas/intoxicação , Overdose de Drogas/terapia , Hemodiafiltração/métodos , Hemoperfusão/métodos , Idoso , Anlodipino/sangue , Anti-Hipertensivos/sangue , Bloqueadores dos Canais de Cálcio/sangue , Di-Hidropiridinas/sangue , Overdose de Drogas/sangue , Overdose de Drogas/diagnóstico , Overdose de Drogas/fisiopatologia , Humanos , Masculino , Insuficiência de Múltiplos Órgãos/induzido quimicamente , Insuficiência de Múltiplos Órgãos/terapia , Choque/induzido quimicamente , Choque/terapia , Fatores de Tempo , Resultado do TratamentoRESUMO
The pharmacokinetics of isradipine, a calcium-channel blocker, have been studied in eight patients on chronic haemodialysis. A single oral dose of 5 mg was administered on both a non-haemodialysis and a haemodialysis day and the plasma concentrations of isradipine were analyzed. The mean cmax, tmax, AUC, and t1/2 in plasma on the non-haemodialysis day were 5.2 ng.ml-1, 1.4 h, 23.8 ng.h.ml-1, and 3.1 h, respectively. The dialysis clearance of isradipine was negligible (5.0 ml.min-1). The t1/2 values during haemodialysis were not significantly different from those observed during the same period post dose on the non-haemodialysis day. The study demonstrates that supplemental doses of isradipine are not necessary in these patients since isradipine is not significantly removed by haemodialysis.