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Calcium Channel Blocker Overdose Causes Acute Respiratory Distress Syndrome and Acute Kidney Injury in a 15-Year-Old Female

Calcium channel blockers (CCBs) are among the most commonly prescribed cardiovascular medications in the adult population. Approximately 20% of adults with hypertension in the United States are prescribed dihydropyridine calcium channel blockers. Similarly, in the pediatric population, CCBs such as...

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Autores principales: Welsh, Larsen H, Bose, Jeremy T, Sahhar, Hanna S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10508704/
https://www.ncbi.nlm.nih.gov/pubmed/37731443
http://dx.doi.org/10.7759/cureus.43806
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author Welsh, Larsen H
Bose, Jeremy T
Sahhar, Hanna S
author_facet Welsh, Larsen H
Bose, Jeremy T
Sahhar, Hanna S
author_sort Welsh, Larsen H
collection PubMed
description Calcium channel blockers (CCBs) are among the most commonly prescribed cardiovascular medications in the adult population. Approximately 20% of adults with hypertension in the United States are prescribed dihydropyridine calcium channel blockers. Similarly, in the pediatric population, CCBs such as nifedipine and amlodipine are frequently prescribed in the non-emergent management of hypertension in children and adolescents. Despite the prevalence of CCB usage, the available literature on the management of calcium channel blocker toxicity in the pediatric population remains scarce. In the absence of formal guidelines, the management of CCB overdoses comes from case reports. This case identifies a 15-year-old Hispanic female who developed acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) after an overdose of amlodipine. Our patient presented with profound, refractory hypotension requiring substantial inotropic support. She subsequently developed significant dyspnea, desaturating into the 80s with radiological evidence of ARDS requiring endotracheal intubation. After aggressive diuresis and electrolyte replacement, along with inotropic agents to maintain adequate blood pressure, our patient began to make significant clinical progress. With continued improvement and resolution of her AKI and ARDS, she was successfully weaned off ventilatory support and all infusions. Our patient was deemed medically appropriate for discharge 10 days after the initial presentation and was admitted to an inpatient psychiatric unit. Calcium channel blocker toxicity can pose considerable risks, as was seen with our patient. Prompt recognition and judicious management of CCB overdoses can mitigate associated morbidity and mortality, resulting in favorable outcomes for patients. The intention behind documenting this case is to contribute to the limited literature on the successful management of calcium channel blocker poisoning in the pediatric population.
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spelling pubmed-105087042023-09-20 Calcium Channel Blocker Overdose Causes Acute Respiratory Distress Syndrome and Acute Kidney Injury in a 15-Year-Old Female Welsh, Larsen H Bose, Jeremy T Sahhar, Hanna S Cureus Pediatrics Calcium channel blockers (CCBs) are among the most commonly prescribed cardiovascular medications in the adult population. Approximately 20% of adults with hypertension in the United States are prescribed dihydropyridine calcium channel blockers. Similarly, in the pediatric population, CCBs such as nifedipine and amlodipine are frequently prescribed in the non-emergent management of hypertension in children and adolescents. Despite the prevalence of CCB usage, the available literature on the management of calcium channel blocker toxicity in the pediatric population remains scarce. In the absence of formal guidelines, the management of CCB overdoses comes from case reports. This case identifies a 15-year-old Hispanic female who developed acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) after an overdose of amlodipine. Our patient presented with profound, refractory hypotension requiring substantial inotropic support. She subsequently developed significant dyspnea, desaturating into the 80s with radiological evidence of ARDS requiring endotracheal intubation. After aggressive diuresis and electrolyte replacement, along with inotropic agents to maintain adequate blood pressure, our patient began to make significant clinical progress. With continued improvement and resolution of her AKI and ARDS, she was successfully weaned off ventilatory support and all infusions. Our patient was deemed medically appropriate for discharge 10 days after the initial presentation and was admitted to an inpatient psychiatric unit. Calcium channel blocker toxicity can pose considerable risks, as was seen with our patient. Prompt recognition and judicious management of CCB overdoses can mitigate associated morbidity and mortality, resulting in favorable outcomes for patients. The intention behind documenting this case is to contribute to the limited literature on the successful management of calcium channel blocker poisoning in the pediatric population. Cureus 2023-08-20 /pmc/articles/PMC10508704/ /pubmed/37731443 http://dx.doi.org/10.7759/cureus.43806 Text en Copyright © 2023, Welsh et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Pediatrics
Welsh, Larsen H
Bose, Jeremy T
Sahhar, Hanna S
Calcium Channel Blocker Overdose Causes Acute Respiratory Distress Syndrome and Acute Kidney Injury in a 15-Year-Old Female
title Calcium Channel Blocker Overdose Causes Acute Respiratory Distress Syndrome and Acute Kidney Injury in a 15-Year-Old Female
title_full Calcium Channel Blocker Overdose Causes Acute Respiratory Distress Syndrome and Acute Kidney Injury in a 15-Year-Old Female
title_fullStr Calcium Channel Blocker Overdose Causes Acute Respiratory Distress Syndrome and Acute Kidney Injury in a 15-Year-Old Female
title_full_unstemmed Calcium Channel Blocker Overdose Causes Acute Respiratory Distress Syndrome and Acute Kidney Injury in a 15-Year-Old Female
title_short Calcium Channel Blocker Overdose Causes Acute Respiratory Distress Syndrome and Acute Kidney Injury in a 15-Year-Old Female
title_sort calcium channel blocker overdose causes acute respiratory distress syndrome and acute kidney injury in a 15-year-old female
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10508704/
https://www.ncbi.nlm.nih.gov/pubmed/37731443
http://dx.doi.org/10.7759/cureus.43806
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