What question did this study set out to answer?

To discuss the challenges and management strategies for severe amlodipine overdose leading to shock and cardiac arrest.

May 20, 2026

C49-41 Pressure Cooker: Managing Shock in Amlodipine Overdose

Key Points

To discuss the challenges and management strategies for severe amlodipine overdose leading to shock and cardiac arrest.
Case report of a 46-year-old female with severe amlodipine overdose and hypotension
Management included aggressive intravenous fluid resuscitation, vasopressors, and ECMO consideration
Patient underwent cardiopulmonary resuscitation after recurrent cardiac arrest
Patient presented with severe hypotension (MAP 50) and required high doses of norepinephrine and other vasopressors
Despite aggressive management, including ECMO cannulation, patient experienced recurrent cardiac arrest and did not achieve spontaneous circulation
Management of amlodipine overdose resulted in significant mortality risks despite intervention efforts.

Abstract

Abstract Introduction Calcium channel blockers (CCBs) are widely prescribed for hypertension, angina, and arrhythmias. According to the 2023 National Poison Data System (NPDS) report, calcium antagonists rank among the top substances linked to fatalities. Amlodipine’s potent vasodilatory effects, large volume of distribution and high protein-binding affinity make poisoning cases difficult to manage. Description A 46-year-old female with a past medical history of Hypertension and Schizophrenia, presented for a suicide attempt. She endorsed taking approximately 90 tablets of 10 mg Amlodipine, 12 hours prior to presentation to the emergency department (ED). Vitals at presentation were significant for a blood pressure of 82/50, and heart rate of 102. Lab findings were significant for lactate 6.1, and potassium 2.7. Poison control was contacted by the ED staff who recommended 8-12 hours of observation. While in the ED her mean arterial pressure (MAP) dropped to 50 despite aggressive intravenous fluid resuscitation (IVF). She was initiated on norepinephrine and received aggressive repletion of calcium. She was admitted to the intensive care unit (ICU) for further management of hemodynamic instability requiring vasopressors due to Amlodipine overdose. She ultimately decompensated and requiring cardiopulmonary resuscitation (CPR), she was resuscitated for 35-40 minutes until spontaneous circulation was achieved. She required high doses of norepinephrine, epinephrine, vasopressin, and methylene blue. Her chest x-ray displayed diffuse bilateral infiltrates, along with poor lung volumes. Oxygenate was difficult despite 100% FIO2. Cardiothoracic (CT) surgery was contacted for extracorporeal membrane oxygenation (ECMO) support and the decision was made to cannulate patient for ECMO. Unfortunately, during cannulation, the patient arrested once again, despite 35-40 minutes of resuscitation, spontaneous circulation was not achieved. Discussion Patients with amlodipine overdose may present with severe hypotension, bradycardia, delirium, seizures, and coma. Management of such cases requires a multimodal approach and, in severe cases, extracorporeal membrane oxygenation (ECMO). Despite these interventions, patients have a significant risk of mortality. This abstract is funded by: None

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