Choque vasopléjico por envenenamiento con amlodipino y losartán
Palabras clave:
choque, envenenamiento, agentes antihipertensivos, amlodipino, losartán
Resumen
El choque vasodilatado o también llamado distributivo ocurre cuando las arteriolas presentan una pérdida de contractibilidad por diferentes mecanismos en donde la hipoxia y acidosis suelen ser los principales. La causa más común de este tipo de choque es la sepsis. Sin embargo, existen otras causas como las intoxicaciones con fármacos. Presentamos el manejo en la unidad de cuidados intensivos de un caso de intoxicación con fines de autoeliminación con dosis elevadas de antihipertensivos bloqueantes de canales calcio y antagonistas del receptor de angiotensina II, que requirió soporte hemodinámico y respiratorio.
Citas
1. Landry DW, Oliver JA. The pathogenesis of vasodilatory choque. N Engl J Med. 2001;345(8):588–95. doi: 10.1056/NEJMra002709
2. Smith N, Lopez RA, Silberman M. Distributive choque [Internet]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls; 2022 [cited 2022 Apr 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470316/
3. Stanek EJ, Nelson CE, DeNoftio D. Amlodipine overdose. Ann Pharmacother. 1997;31(7–8):853–6. doi: 10.1177/106002809703100708
4. Chudow M, Ferguson K. A case of severe, refractory hypotension after amlodipine overdose. Cardiovasc Toxicol. 2018;18(2):192–7. doi: 10.1007/s12012-017-9419-x
5. Sadler WD, Hunt N, Nelson K, Adelmann E, Mazurek P, Bassin BS. Calcium channel blocker intoxication: A critical care transport perspective. Air Med J [Internet]. 2021 [cited 2022 Apr 10]; 40(1):69–72. Available from: https://doi.org/10.1016/j.amj.2020.11.004
6. Zegarra J, Meza M, Cornejo C, Porras W, Díaz A, Heredia O, et al. Amlodipino y choque vasodilatado en una unidad de cuidados intensivos de un hospital general. Reporte de caso. Rev Medi Hered [Internet]. 2017 [citado 10 Abr 2022]; 28(2):101-4. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1018-130X2017000200005&lng=es&nrm=iso&tlng=es. doi: https://doi.org/10.20453/rmh.v28i2.3110
7. Moreno Millán E, Rodríguez Muñoz R, Villegas del Ojo J. Hipotensión grave y prolongada tras sobredosis de candesartán y amlodipino por intento autolítico: Primer caso comunicado en la literatura. Rev Toxicol [Internet]. 2012 [citado 10 Abr 2022];29(2):129–31. Disponible en: http://rev.aetox.es/wp/wp-content/uploads/hemeroteca/vol29-2/623-1834-1-SM.pdf
8. Osman AF, Prasad RM, Marein S, O’Brien C. Multi-organ dysfunction as a presentation of calcium channel blocker intoxication. BMJ Case Rep [Internet]. 2022 [cited 2022 Apr 10];15(1):e45711. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8768057/. doi: 10.1136/bcr-2021-245711
9. Nielsen EW. Hypotensive shock and angio-oedema from angiotensin II receptor blocker: A class effect in spite of tripled tryptase values. J Intern Med. 2005;258(4):385–7. doi: 10.1111/j.1365-2796.2005.01547.x
10. Prasa D, Hoffmann-Walbeck P, Barth S, Stedtler U, Ceschi A, Färber E, et al. Angiotensin II antagonists-an assessment of their acute toxicity. Clin Toxicol (Phila). 2013;51(5):429–34.
11. Pellegrini JR, Munshi R, Tiwana MS, Abraham T, Tahir H, Sayedy N, Iqbal J. “Feeling the Blues”: A case of calcium channel blocker overdose managed with methylene blue. Cureus [Internet]. 2021 [cited 2022 Apr 10];13(10): e19114. Available from: https://pubmed.ncbi.nlm.nih.gov/34868762/ doi: 10.7759/cureus.19114
12. Kapelios ChJ, Karamanakos G, Liatis S, Sarafadi M, Polizois M, Papoutsis I, Kokkinos AD. Recurrent episodes of life-threatening vasodilatory shock following unintentional intoxication with amlodipine. Hellenic J Cardiol [Internet]. 2017 [cited 2022 Apr 10];58(5):369–71. Available from: https://pubmed.ncbi.nlm.nih.gov/27986618/. doi: 10.1016/j.hjc.2016.12.001
13. Li R, Xu YW, Xue Y, Wu XZ. Plasmapheresis in the treatment of multi-drug intoxication involving levothyroxine sodium and calcium channel blockers: A case report. Ann Palliat Med [Internet]. 2021 [cited 2022 Apr 10];10(5):5839–45. Available from: https://pubmed.ncbi.nlm.nih.gov/32954749/. doi: 10.21037/apm-20-190
14. Munné P, Arteaga J. Asistencia general al paciente intoxicado. ANALES Sis San Navarra [Internet]. 2003 [citado 30 Mar 2022];26(Supl. 1):21–48. Disponible en: https://scielo.isciii.es/pdf/asisna/v26s1/tres.pdf
15. Torales J, Barrios I, González S. Caracterización de pacientes con conducta suicida hospitalizados en el Servicio de Psiquiatría de un Hospital Universitario. Mem Inst Investig Cienc Salud [Internet]. 2020 [citado 30 Mar 2022];18(2):54–62. Disponible en: http://scielo.iics.una.py/pdf/iics/v18n2/1812-9528-iics-18-02-54.pdf. https://doi.org/10.18004/mem.iics/1812-9528/2020.018.02.54
16. Rietjens SJ, de Lange DW, Donker DW, Meulenbelt J. Practical recommendations for calcium channel antagonist poisoning. Neth J Med [Internet]. 2016 [cited 2022 Apr 10];74(2):60–7. Available from: https://www.njmonline.nl/getpdf.php?id=1674
17. Mináriková M, Fojtikova V, Vyskočilová E, Sedláček J, Šikut M, Borek-Dohalska L, et al. The capacity and effectiveness of diosmectite and charcoal in trapping the compounds causing the most frequent intoxications in acute medicine: A comparative study. Environ Toxicol Pharmacol. 2017;52:214–20. doi: 10.1016/j.etap.2017.04.011
18. Vincent JL, Leone M. Optimum treatment of vasopressor-dependent distributive shock. Expert Rev Anti Infect Ther.;15(1):5–10. doi: 10.1080/14787210.2017.1252673
19. Guerci P, Belveyre T, Mongardon N, Novy E. When to start vasopressin in septic shock : the strategy we propose. Crit Care [Internet]. 2022 [cited 2022 Mar 30];26(125). Available from: https://ccforum.biomedcentral.com/track/pdf/10.1186/s13054-022-04001-4.pdf. https://doi.org/10.1186/s13054-022-04001-4
20. Ebihara T, Morita M, Kawada M, Amano K, Kato F, Nakata Y. Efficacy of isoproterenol for treating amlodipine overdose resulting in bradycardia. Acute Med Surg [Internet] 2017 [cited 2022 Apr 10];4(3):353–7. Available from: https://pubmed.ncbi.nlm.nih.gov/29123890/. doi: 10.1002/ams2.284
21. Laes JR, Williams DM, Cole JB. Improvement in hemodynamics after methylene blue administration in drug-Induced vasodilatory shock: A case report. J Med Toxicol [Internet]. 2015 [cited 2022 Apr 10];11(4):460–3. Available from: https://pubmed.ncbi.nlm.nih.gov/26310944/. doi: 10.1007/s13181-015-0500-1
22. Chou YJ, Lee ChH. Success in early treatment with lipid emulsion for antihypertension drug overdose patient. Am J Emerg Med. 2021;50:814.e3-814.e5. doi: 10.1016/j.ajem.2021.06.043
23. Koliastasis L, Lampadakis I, Milkas A, Strempelas P, Sourides V, Kakava K, et al. Refractory shock from amlodipine overdose overcomed with hyperinsulinemia. Cardiovasc Toxicol [Internet]. 2022 [cited 2022 Mar 30];22(1):63–6. Available from: https://pubmed.ncbi.nlm.nih.gov/34643856/ doi: 10.1007/s12012-021-09699-2
2. Smith N, Lopez RA, Silberman M. Distributive choque [Internet]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls; 2022 [cited 2022 Apr 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470316/
3. Stanek EJ, Nelson CE, DeNoftio D. Amlodipine overdose. Ann Pharmacother. 1997;31(7–8):853–6. doi: 10.1177/106002809703100708
4. Chudow M, Ferguson K. A case of severe, refractory hypotension after amlodipine overdose. Cardiovasc Toxicol. 2018;18(2):192–7. doi: 10.1007/s12012-017-9419-x
5. Sadler WD, Hunt N, Nelson K, Adelmann E, Mazurek P, Bassin BS. Calcium channel blocker intoxication: A critical care transport perspective. Air Med J [Internet]. 2021 [cited 2022 Apr 10]; 40(1):69–72. Available from: https://doi.org/10.1016/j.amj.2020.11.004
6. Zegarra J, Meza M, Cornejo C, Porras W, Díaz A, Heredia O, et al. Amlodipino y choque vasodilatado en una unidad de cuidados intensivos de un hospital general. Reporte de caso. Rev Medi Hered [Internet]. 2017 [citado 10 Abr 2022]; 28(2):101-4. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1018-130X2017000200005&lng=es&nrm=iso&tlng=es. doi: https://doi.org/10.20453/rmh.v28i2.3110
7. Moreno Millán E, Rodríguez Muñoz R, Villegas del Ojo J. Hipotensión grave y prolongada tras sobredosis de candesartán y amlodipino por intento autolítico: Primer caso comunicado en la literatura. Rev Toxicol [Internet]. 2012 [citado 10 Abr 2022];29(2):129–31. Disponible en: http://rev.aetox.es/wp/wp-content/uploads/hemeroteca/vol29-2/623-1834-1-SM.pdf
8. Osman AF, Prasad RM, Marein S, O’Brien C. Multi-organ dysfunction as a presentation of calcium channel blocker intoxication. BMJ Case Rep [Internet]. 2022 [cited 2022 Apr 10];15(1):e45711. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8768057/. doi: 10.1136/bcr-2021-245711
9. Nielsen EW. Hypotensive shock and angio-oedema from angiotensin II receptor blocker: A class effect in spite of tripled tryptase values. J Intern Med. 2005;258(4):385–7. doi: 10.1111/j.1365-2796.2005.01547.x
10. Prasa D, Hoffmann-Walbeck P, Barth S, Stedtler U, Ceschi A, Färber E, et al. Angiotensin II antagonists-an assessment of their acute toxicity. Clin Toxicol (Phila). 2013;51(5):429–34.
11. Pellegrini JR, Munshi R, Tiwana MS, Abraham T, Tahir H, Sayedy N, Iqbal J. “Feeling the Blues”: A case of calcium channel blocker overdose managed with methylene blue. Cureus [Internet]. 2021 [cited 2022 Apr 10];13(10): e19114. Available from: https://pubmed.ncbi.nlm.nih.gov/34868762/ doi: 10.7759/cureus.19114
12. Kapelios ChJ, Karamanakos G, Liatis S, Sarafadi M, Polizois M, Papoutsis I, Kokkinos AD. Recurrent episodes of life-threatening vasodilatory shock following unintentional intoxication with amlodipine. Hellenic J Cardiol [Internet]. 2017 [cited 2022 Apr 10];58(5):369–71. Available from: https://pubmed.ncbi.nlm.nih.gov/27986618/. doi: 10.1016/j.hjc.2016.12.001
13. Li R, Xu YW, Xue Y, Wu XZ. Plasmapheresis in the treatment of multi-drug intoxication involving levothyroxine sodium and calcium channel blockers: A case report. Ann Palliat Med [Internet]. 2021 [cited 2022 Apr 10];10(5):5839–45. Available from: https://pubmed.ncbi.nlm.nih.gov/32954749/. doi: 10.21037/apm-20-190
14. Munné P, Arteaga J. Asistencia general al paciente intoxicado. ANALES Sis San Navarra [Internet]. 2003 [citado 30 Mar 2022];26(Supl. 1):21–48. Disponible en: https://scielo.isciii.es/pdf/asisna/v26s1/tres.pdf
15. Torales J, Barrios I, González S. Caracterización de pacientes con conducta suicida hospitalizados en el Servicio de Psiquiatría de un Hospital Universitario. Mem Inst Investig Cienc Salud [Internet]. 2020 [citado 30 Mar 2022];18(2):54–62. Disponible en: http://scielo.iics.una.py/pdf/iics/v18n2/1812-9528-iics-18-02-54.pdf. https://doi.org/10.18004/mem.iics/1812-9528/2020.018.02.54
16. Rietjens SJ, de Lange DW, Donker DW, Meulenbelt J. Practical recommendations for calcium channel antagonist poisoning. Neth J Med [Internet]. 2016 [cited 2022 Apr 10];74(2):60–7. Available from: https://www.njmonline.nl/getpdf.php?id=1674
17. Mináriková M, Fojtikova V, Vyskočilová E, Sedláček J, Šikut M, Borek-Dohalska L, et al. The capacity and effectiveness of diosmectite and charcoal in trapping the compounds causing the most frequent intoxications in acute medicine: A comparative study. Environ Toxicol Pharmacol. 2017;52:214–20. doi: 10.1016/j.etap.2017.04.011
18. Vincent JL, Leone M. Optimum treatment of vasopressor-dependent distributive shock. Expert Rev Anti Infect Ther.;15(1):5–10. doi: 10.1080/14787210.2017.1252673
19. Guerci P, Belveyre T, Mongardon N, Novy E. When to start vasopressin in septic shock : the strategy we propose. Crit Care [Internet]. 2022 [cited 2022 Mar 30];26(125). Available from: https://ccforum.biomedcentral.com/track/pdf/10.1186/s13054-022-04001-4.pdf. https://doi.org/10.1186/s13054-022-04001-4
20. Ebihara T, Morita M, Kawada M, Amano K, Kato F, Nakata Y. Efficacy of isoproterenol for treating amlodipine overdose resulting in bradycardia. Acute Med Surg [Internet] 2017 [cited 2022 Apr 10];4(3):353–7. Available from: https://pubmed.ncbi.nlm.nih.gov/29123890/. doi: 10.1002/ams2.284
21. Laes JR, Williams DM, Cole JB. Improvement in hemodynamics after methylene blue administration in drug-Induced vasodilatory shock: A case report. J Med Toxicol [Internet]. 2015 [cited 2022 Apr 10];11(4):460–3. Available from: https://pubmed.ncbi.nlm.nih.gov/26310944/. doi: 10.1007/s13181-015-0500-1
22. Chou YJ, Lee ChH. Success in early treatment with lipid emulsion for antihypertension drug overdose patient. Am J Emerg Med. 2021;50:814.e3-814.e5. doi: 10.1016/j.ajem.2021.06.043
23. Koliastasis L, Lampadakis I, Milkas A, Strempelas P, Sourides V, Kakava K, et al. Refractory shock from amlodipine overdose overcomed with hyperinsulinemia. Cardiovasc Toxicol [Internet]. 2022 [cited 2022 Mar 30];22(1):63–6. Available from: https://pubmed.ncbi.nlm.nih.gov/34643856/ doi: 10.1007/s12012-021-09699-2
