(19.12) Navigating the Depths of Overdose: Extreme Insulin Therapy in Severe Amlodipine

Calcium channel blockers are commonly prescribed antihypertensives that pose a high potential for toxicity. This case report aims to elucidate the life-threatening complications arising from amlodipine overdose, shedding light on the critical importance of prompt recognition and aggressive insulin therapy in managing acute calcium channel blocker toxicity.

Case(s) Description :

Presented is the case of a 74-year-old male with a history of hypertension and stroke who ingested more than 400 mg of amlodipine in a deliberate act of self-harm. Laboratory data were notable for hyperglycemia. Sepsis workup was negative. Based on these findings, the patient was diagnosed with calcium channel blocker toxicity and admitted to the intensive care unit for further management. The case patient required infusion of up to 850 units/hour of continuous insulin for almost five days.  Hypotension and hyperglycemia responded to high-dose insulin therapy and the patient experienced full resolution of symptoms. 

Discussion :

Amlodipine, a dihydropyridine calcium channel blocker, disrupts calcium influx, impacting blood pressure and insulin secretion. Severe calcium channel blocker toxicity is characterized by hyperglycemia and hypotension. Treatment involves hyperinsulinemic-euglycemic therapy, continuous calcium infusion, and vasopressors. Our case required unprecedentedly high insulin doses, challenging medical staff due to concerns about hypoglycemia.

This case underscores the gravity of amlodipine overdose, emphasizing the efficacy and safety of hyperinsulinemic-euglycemic therapy in managing severe calcium channel blocker toxicity. Clinicians must be cognizant of the potential need for exceptionally high insulin doses, and their readiness to overcome initial reluctance is paramount for optimal patient outcomes.