liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
The unknown known: non-cardiogenic pulmonary edema in amlodipine poisoning, a cohort study
Swedish Poisons Informat Ctr, Sweden.
Skane Univ Hosp, Sweden.
Natl Board Forens Med, Dept Forens Genet and Forens Toxicol, Linkoping, Sweden.
Linköping University, Department of Biomedical and Clinical Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Natl Board Forens Med, Dept Forens Genet and Forens Toxicol, Linkoping, Sweden.
Show others and affiliations
2020 (English)In: Clinical Toxicology, ISSN 1556-3650, E-ISSN 1556-9519, Vol. 58, no 11, p. 1042-1049Article in journal (Refereed) Published
Abstract [en]

Context: Amlodipine is the most common calcium channel blocker (CCB) on the Swedish market, and poison center (PC) consultations for amlodipine overdoses are increasing. The clinical picture is dominated by vasodilation with relative preservation of cardiac function. CCBs selectively dilate vessels on the afferent side of the capillary network which, in states of preserved or increased blood flow may lead to edema formation, including non-cardiogenic pulmonary edema (NCPE). This complication has been considered rare in CCB poisoning. In this cohort study of nineteen amlodipine poisonings with high amlodipine blood levels, the incidence and clinical significance of NCPE in severe amlodipine poisoning are explored. Methods: During 2017-2018 the Swedish PC prospectively encouraged the gathering of blood samples in amlodipine poisonings with symptoms requiring treatment with inotropes or vasopressors. Samples were sent by mail to the Forensic Toxicology Division at the Swedish National Board of Forensic Medicine for screening and quantification of relevant toxicants. Patients with blood amlodipine levels amp;gt;0.25 mu g/mL were included in a cohort whose case details were gathered from medical records and PC-case notes with a special focus on signs of NCPE. Results: Nineteen patients met the blood amlodipine inclusion criteria. Four (21%) died and one patient was treated with VA-ECMO. Nine patients developed NCPE defined as a need for positive pressure ventilation (PPV) while having an echocardiographically normal left ventricular function. Conclusion: In this prospective cohort study of consecutive and analytically confirmed significant amlodipine poisonings NCPE was a common finding occurring in 47% of the whole cohort and in 64% of patients who did not go on to develop complete hemodynamic collapse.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD , 2020. Vol. 58, no 11, p. 1042-1049
Keywords [en]
Calcium channel blocker overdose; vasoplegia; high dose insulin therapy
National Category
Pharmacology and Toxicology
Identifiers
URN: urn:nbn:se:liu:diva-164876DOI: 10.1080/15563650.2020.1725034ISI: 000518257600001PubMedID: 32114860OAI: oai:DiVA.org:liu-164876DiVA, id: diva2:1417737
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2021-04-16

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Ahlner, Johan
By organisation
Division of Drug ResearchFaculty of Medicine and Health Sciences
In the same journal
Clinical Toxicology
Pharmacology and Toxicology

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 71 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf