Introduction: Calcium channel blocker (CCB) overdose, particularly with dihydropyridines like amlodipine, can cause profound vasodilatory shock and multi-organ dysfunction. Such poisoning often requires aggressive critical care interventions. Case presentation: A 23-year-old Ethiopian man attempted suicide by ingesting ⩾300 mg of amlodipine (plus diclofenac). He developed refractory hypotension, bradyarrhythmia, acute kidney injury, and non-cardiogenic pulmonary edema. He subsequently required intubation and suffered a cardiac arrest. Management and outcome: He received standard supportive therapy: Intravenous (IV) crystalloid boluses, calcium gluconate, escalating vasopressors (norepinephrine/epinephrine), and high-dose insulin-glucose infusion with potassium supplementation. Despite multiorgan failure (renal failure, pulmonary edema) and arrest, he recovered gradually over 2 weeks with full neurologic return. Corticosteroids, diuretics, and broad-spectrum antibiotics were adjunctively used. Conclusion: This case illustrates that even a massive amlodipine overdose with multiorgan failure and arrest can be survived with early, multimodal intensive care. It showcases the need for early recognition of CCB toxicity and prompt use of therapies such as high-dose insulin and extracorporeal support if needed.
Mengistie et al. (Mon,) studied this question.