Successful treatment of suicide attempt by megadose of propafenone and captopril.

Intoxication caused by propafenone is very rare, and there is no case reported before propafenone and captopril intoxication together. There are few case reports in the literature about intoxication with more than 6 g of propafenone. We present the clinical manifestation and successfully treatment of 9 g of propafenone and 1 g captopril intoxication in an 18-year-old female. An 18-year-old female was brought to the emergency department approximately half an hour after she committed suicide with 30 propafenone tablets, 300 mg each, and 20 captopril tablets, 50 mg each. Her fist electrocardiography (ECG) shows a chaotic ventricular rhythm with a prolonged QRS complex. After fluid and sodium bicarbonate infusion and permanent pacemaker implantation, sinus rhythm was achieved. This case, to our knowledge, is the first in that it describes the successful recovery of a patient who ingested extensively large doses of propafenone (9 g) and captopril (1 g), both of which are known to have severe cardiac side effects.

[Intentional poisoning with ACE inhibitors. Emergeny Hospital Iasi]. / Toxicitatea acuta a inhibitorilor enzimei de conversie a angiotensinei. Experienta clinicii de medicina interna si toxicologie, spitalul clinic de urgente "SF Ioan" Iasi.

UNLABELLED: Regarding angiotensin-converting enzyme inhibitors (ACEI) poisoning, only few data are available in the last decade literature. In the previous couple of years especially isolated case reports were published. MATERIAL AND METHOD: We analyzed retrospectively all the patients with acute ACEI poisoning admitted in Iasi Internal Medicine and Toxicology Clinic between 2004 and 2009. RESULTS: 17 cases of poisoning were recorded (enalapril-9 cases, captopril-3 cases, perindopril-3 cases, lisinopril-2 cases). All the poisonings were intentional. A favorable outcome was consistently observed, and were recorded no sequelae or death in this study. The main complain was hypotension, required fluid administration, only one case with 500 mg enalaprilum and severe hypotension required injection of vasopressive amines. No abnormal renal function and no angioedema were noted.

Naloxone reversal of hypotension due to captopril overdose.

The hemodynamic effects of captopril and other angiotensin-converting enzyme inhibitors may be mediated by the endogenous opioid system. The opioid antagonist naloxone has been shown to block or reverse the hypotensive actions of captopril. We report a case of an intentional captopril overdose, manifested by marked hypotension, that resolved promptly with the administration of naloxone. To our knowledge, this is the first reported case of captopril-induced hypotension treated with naloxone. Our experience demonstrates a possible role of naloxone in the reversal of hypotension resulting from captopril.

Uneventful self poisoning with a very high dose of captopril.

A 43-year-old patient with mild heart failure attempted suicide by ingesting between 5000 and 7500 mg of captopril. Blood pressure oscillated around 100-120/50-75 mmHg and pulse rate showed no tendency to accelerate (75-100/min). The psychiatric examination showed no drug induced psychopathological symptoms. The calculated half-life of captopril was 4.4 h. Seven hours after ingestion of approximately 50 times the maximal therapeutic daily dose of captopril the serum concentration reached 20 micrograms/ml. The calculated amount of absorbed captopril was approximately 5400 mg. Atrial natriuretic factor (ANF) plasma levels were slightly elevated and showed no tendency to increase or to fall.

Suicide by captopril overdose.

We report a case of a 75 year-old male who committed suicide by taking an overdose of captopril. He took approximately ninety 12.5 mg captopril tablets. The postmortem plasma concentration of captopril was 60.4 mg/L. A review of the medical literature revealed five cases of captopril overdose all from unsuccessful suicide attempts. To our knowledge, this is the first case report of fatal captopril overdose with the measurement of plasma concentration of the drug.

Angiotensin converting enzyme inhibitor ingestion in children.

The effect of angiotensin converting enzyme inhibitors on children is not well documented. A recent increase in popularity of the angiotensin converting enzyme inhibitors has resulted in an increased availability in the home with resulting heightened probability of accidental ingestion of angiotensin converting enzyme inhibitors by children. In response to this we did a retrospective study of angiotensin converting enzyme inhibitor ingestions in children (ages 1-5 years) from two regional poison centers certified by the American Association of Poison Control Centers. The records of the Delaware Valley Regional Poison Control Center and the New Jersey Poison Information Education Systems were reviewed for 1986 and 1987. Forty-eight angiotensin converting enzyme inhibitor exposures in children 1-5 were identified. Twenty exposures (12.5-300mg captopril, 5-15mg enalapril) were managed with syrup of ipecac in a hospital emergency room. All 20 remained asymptomatic for their stay. None required admission to the hospital. Seven exposures (12.5-75mg captopril, 5-10mg enalapril) were managed at home with syrup of ipecac and 1-, 4-, 24-hour follow up by telephone. All 7 remained asymptomatic. 16 exposures (12.5-100mg captopril, 5-30mg enalapril) were managed by phone at home with observation alone and 4-6 hour follow up. All 16 remained asymptomatic. Five exposures were lost to follow up. A larger series is needed to determine risk, but home monitoring seems adequate for children ingesting no more than the therapeutic dose for adults (12.5-100 mg captopril, 5-30 mg enalapril).

Captopril overdose resulting in hypotension.

We present a case in which a patient took an overdose of captopril (Capoten) and alprazolam (Xanax) in a suicide attempt. The patient presented with hypotension (systolic blood pressure of 80 mm Hg) and drowsiness. The hypotension initially responded to administration of intravenous fluids and dopamine; however, it recurred twice at 18.5 and 24.5 hours after ingestion. These episodes again responded to administration of fluids and dopamine. A plasma captopril level of 27,391.1 nmol/L (5982 ng/mL) was documented, as well as a depressed level of angiotensin converting enzyme. Captopril is an angiotensin converting enzyme inhibitor used in the management of hypertension and ventricular failure; to our knowledge, this is the first case of an acute captopril overdose reported in the English-language literature. The role of captopril in inducing hypotension is discussed herein.