Massive Atenolol, Lisinopril, and Chlorthalidone Overdose Treated with Endoscopic Decontamination, Hemodialysis, Impella Percutaneous Left Ventricular Assist Device, and ECMO

Background Overdose of cardiovascular medications is increasingly associated with morbidity and mortality. We present a case of substantial atenolol, chlorthalidone, and lisinopril overdose treated by multiple modalities with an excellent outcome. Conclusion Aggressive medical intervention did not p...

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Bibliographic Details
Published in:Journal of medical toxicology 2015-03, Vol.11 (1), p.110-114
Main Authors: Heise, C. William, Beutler, David, Bosak, Adam, Orme, Geoffrey, Loli, Akil, Graeme, Kimberlie
Format: Article
Language:English
Subjects:
Adrenergic beta-1 Receptor Antagonists - poisoning
Adult
Atenolol
Atenolol - poisoning
Biomedical and Life Sciences
Biomedicine
Cardiovascular Agents - poisoning
Cardiovascular disease
Chlorthalidone - poisoning
Combined Modality Therapy
Contamination
Decontamination
Drug overdose
Drug Overdose - physiopathology
Drug Overdose - surgery
Drug Overdose - therapy
Emergency Service, Hospital
Endoscopes
Endoscopy, Digestive System
Extracorporeal Membrane Oxygenation
Female
Heart
Hemodialysis
Hemodynamics
Humans
Lisinopril - poisoning
Morbidity
Multiple Organ Failure - etiology
Overdose
Oxygenation
Pharmacology/Toxicology
Renal Dialysis
Shock, Cardiogenic - etiology
Tablets
Toxicology Observation
Transcutaneous Electric Nerve Stimulation
Treatment Outcome
Ventricle
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Summary:Background Overdose of cardiovascular medications is increasingly associated with morbidity and mortality. We present a case of substantial atenolol, chlorthalidone, and lisinopril overdose treated by multiple modalities with an excellent outcome. Conclusion Aggressive medical intervention did not provide sufficient hemodynamic stability in this patient with refractory cardiogenic and distributive shock. Impella® percutaneous left ventricular assist device and extracorporeal membrane oxygenation provided support while the effects of the overdose subsided. We present concentrations demonstrating removal of atenolol with continuous venovenous hemodiafiltration. This is the first report of esophagogastroduo denoscopy decontamination of this overdose with a large pill fragment burden.
ISSN:1556-9039
1937-6995
DOI:10.1007/s13181-014-0419-y