A Case of Life-threatening Amlodipine and Atenolol Overdose

Treating a patient of amlodipine-atenolol poisoning is nightmare for a physician.In high dose both the drugs individually cause severe bradycardia and hypotension.In combination they cause severe cardiovascular depression.Here we report a case of 66-year-old obese, hypertensive, depressed male, who presented to emergency 9 hours after consumption of 25 tablets of amlodipine-atenolol (5 mg+50 mg).On evaluation, he had refractory bradycardia, hypotension and acute kidney injury (AKI).Eventually he developed cardiac arrest.He was revived after 5 minutes of cardio-pulmonary resuscitation (CPR).He was successfully managed with gastric lavage, fluids, inotropes, atropine, isoprenaline and subsequently with calcium gluconate infusion, high-dose insulin euglycemia therapy (HIET) and lipid emulsion therapy.Glucagon infusion was also planned but it was not available.Patient hemodynamics improved and on 8th day he got the discharge.Our case exemplifies the importance of timely and aggressive management of lethal overdose of amlodipine-atenolol poisoning.