Competing therapy options for severe amlodipine poisoning—lessons learned: a case report

BACKGROUND: We report two cases of severe amlodipine poisoning (> 1000 mg) during a suicide attempt. CASE PRESENTATION: Both patients (male, white, aged 70 and 28 years, respectively) experienced severe vasoplegic shock and were referred to us from regional hospitals via our extracorporeal membrane oxygenation hotline. In addition to the recommended therapy, both patients underwent albumin dialysis. Despite this, the vasopressor demand remained sky high, in both cases above 2 µg/kg/minute norepinephrine. Ultimately, both patients required veno-arterial extracorporeal membrane oxygenation support. There were slight differences in treatment; one patient received lipid emulsion and the other hydroxycobalamin, both of which caused interesting technical difficulties with continuous renal replacement therapy. Finally, we were able to wean both patients off extracorporeal support as well as all vasopressors. Both were discharged from the intensive care unit. CONCLUSION: In cases so severe, swift action is of the essence and some of the available treatments cancel each other out and should be timed accordingly. Therefore, on the basis of our experiences and the standing recommendations we developed a treatment algorithm that takes not only the case severity but also the time frame in which the treatment should be administered into account.