lisinopril and Drug-Overdose

Angiotensin-converting enzyme (ACE) inhibitor overdose is an uncommonly presenting toxicologic emergency. Management is primarily supportive care, but a small body of evidence exists to support naloxone for management of hypotension.. We present a case of accidental ACE inhibitor overdose. The patient took approximately 300 mg lisinopril over 48 h and presented for evaluation of syncope. He was hypotensive and unresponsive to fluids. We administered naloxone with immediate and sustained resolution in hypotension. The mechanism of action is briefly discussed. WHY SHOULD AN EMERGENCY MEDICINE PHYSICIAN BE AWARE OF THIS?: Naloxone is a rapid, low-risk, low-cost, and effective intervention for hypotension due to ACE inhibitor toxicity. It is supported by basic science research and clinical experience.

Topics: Angiotensin-Converting Enzyme Inhibitors; Drug Overdose; Humans; Hypotension; Lisinopril; Male; Naloxone

BACKGROUND Synthetic cannabinoids have a higher affinity for the cannabinoid receptors CB1 and CB2 than natural cannabinoids. Their use can be associated with cardiovascular disease and neurological complications. A case is reported of status epilepticus and stress cardiomyopathy following the recreational use of the synthetic cannabinoid, UR-144. CASE REPORT A 19-year-old woman presented to the emergency department in status epilepticus after smoking the synthetic cannabinoid known as 'space'. Recurring seizure activity was controlled after three hours. On hospital day 3, the patient developed severe biventricular failure. Cardiac magnetic resonance imaging (MRI) confirmed the diagnosis of stress cardiomyopathy. A comprehensive urine drug screen was performed using gas chromatography-mass spectrometry (GC-MS), which was positive for UR-144, or (1-pentyl-1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl)-methanone, and negative for all other illicit recreational drugs. The patient improved at one week following admission, with a left ventricular ejection fraction (LVEF) of 40%. She was discharged home on hospital day 10. CONCLUSIONS The use of the synthetic cannabinoid, UR-144, may be associated with prolonged status epilepticus and stress cardiomyopathy. Physicians should be aware of these potentially lethal complications associated with the recreational use of this and other illicit synthetic cannabinoids.

Topics: Bisoprolol; Cannabinoids; Drug Overdose; Female; Gas Chromatography-Mass Spectrometry; Humans; Indoles; Lisinopril; Smoking; Status Epilepticus; Substance Abuse Detection; Takotsubo Cardiomyopathy; Young Adult

Topics: Aged, 80 and over; Anti-Arrhythmia Agents; Antihypertensive Agents; Atorvastatin; Atrial Fibrillation; Bone Density Conservation Agents; Deprescriptions; Digoxin; Diltiazem; Diuretics; Drug Overdose; Factor Xa Inhibitors; Female; Furosemide; Heart Failure; Histamine H1 Antagonists, Non-Sedating; Histamine H2 Antagonists; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Ibandronic Acid; Lisinopril; Loratadine; Metoprolol; Polypharmacy; Pyrazoles; Pyridones; Ranitidine; Syncope

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.. 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.

Topics: Adrenergic beta-1 Receptor Antagonists; Adult; Atenolol; Cardiovascular Agents; Chlorthalidone; Combined Modality Therapy; Decontamination; Drug Overdose; Emergency Service, Hospital; Endoscopy, Digestive System; Extracorporeal Membrane Oxygenation; Female; Humans; Lisinopril; Multiple Organ Failure; Renal Dialysis; Shock, Cardiogenic; Tablets; Transcutaneous Electric Nerve Stimulation; Treatment Outcome

A case of apparent overdose of angiotensin-converting-enzyme inhibitors requiring hemodialysis is reported.. A 51-year-old white man (weight, 85 kg; height, 178 cm; body mass index, 28) with a history of hypertension, low back pain, and anxiety apparently took 27 lisinopril 10-mg tablets (3.18 mg/kg body weight) over a period of 3 or fewer days. The friend who brought him to the emergency department reported that the patient was hard to rouse and was speaking incoherently on the day of admission. Over the previous few days, the patient reportedly had visual hallucinations, incoherence, and inarticulate speech. Laboratory tests, electrocardiography, and computed tomography were performed. The patient was judged to have high-anion-gap metabolic acidosis, acute kidney injury, severe hyperkalemia, and rhabdomyolysis. He was given three doses of albuterol via a nebulizer, three doses of calcium gluconate 1 g i.v., two doses of sodium bicarbonate 100 meq i.v., two doses of sodium polystyrene sulfonate 30 g orally, three doses of insulin 10 units i.v., and three doses of dextrose 25 g (as 50% dextrose injection) i.v. He then underwent emergent hemodialysis and was admitted to the intensive care unit. The patient's confusion abated, kidney function improved, and acid-base and electrolyte imbalances resolved. The patient was discharged after 15 days.. A man who had evidently taken an overdose of lisinopril had multiorgan dysfunction in the absence of hypotension. The abnormalities resolved after he was treated for acidosis and hyperkalemia and received hemodialysis to remove the lisinopril.

Topics: Acute Kidney Injury; Angiotensin-Converting Enzyme Inhibitors; Drug Overdose; Humans; Lisinopril; Male; Middle Aged; Renal Dialysis

We present a rare case of a 13-year-old girl who took an intentional mixed overdose of nicorandil, lisinopril and metoclopramide. This is the first reported case in the literature of nicorandil overdose in the paediatric age group. The chief presenting clinical signs were hypoxia, peripheral hypoperfusion and hypotension with tachycardia unresponsive to aggressive intravenous volume expansion. Subsequent ECG changes suggested evolving myocardial ischaemia and were accompanied by complaints of back pain and worsening shortness of breath. Vasopressor therapy led to an immediate resolution of the ECG changes and improved the hypotension. This was continued for a further 24 h, until haemodynamic stability was achieved.

Topics: Adolescent; Antihypertensive Agents; Arrhythmias, Cardiac; Drug Overdose; Electrocardiography; Female; Humans; Hypotension; Lisinopril; Nicorandil; Norepinephrine; Suicide, Attempted; Vasoconstrictor Agents

Topics: Age Factors; Child; Child, Preschool; Citalopram; Dose-Response Relationship, Drug; Drug Overdose; Humans; Lisinopril; Poison Control Centers; Poisoning

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Dose-Response Relationship, Drug; Drug Overdose; Female; Humans; Hyponatremia; Lisinopril; Psychoses, Substance-Induced; Suicide, Attempted

This report describes a case of lisinopril overdose managed in part with an infusion of angiotensin II in a patient with dilated cardiomyopathy and reviews other literature reporting angiotensin-converting enzyme (ACE) inhibitor overdose.. Information concerning this patient was obtained through review of the medical chart, conversation with the attending physician, and personal involvement late in the course of the patient's therapy. We conducted MEDLINE and PAPERCHASE searches of the English language literature (restricted to human studies) from 1976 to the present, manually searched Current Contents and references from each publication reviewed, and contacted the manufacturer of lisinopril for any further references they could provide.. All case reports that described an ACE inhibitor overdose.. Case reports were evaluated for the ACE inhibitor involved, amount ingested, and therapeutic management.. Ten patients with ACE inhibitor overdose have been reported, most of whom required only intravenous fluids for blood pressure support. The case presented here is the second report in which the patient's blood pressure was not adequately controlled with fluid and traditional vasopressors and required an infusion of angiotensin II.. Although only a few cases of ACE inhibitor overdose have been reported, it is possible that with widespread use of these agents, overdose may become a more common problem. Management of ACE inhibitor overdose should include general supportive care, gut decontamination when possible, intravenous fluids, and vasopressors if necessary. Intravenous angiotensin II may be effective in situations in which traditional vasopressors fail, and is a physiologically rational treatment.

Topics: Angiotensin II; Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Cardiomyopathy, Dilated; Creatinine; Drug Overdose; Humans; Infusions, Intravenous; Lisinopril; Male; Medication Errors; Middle Aged