Calcium channel blocker and angiotensin receptor blocker toxicity: A case report

Calcium channel blockers and angiotensin II receptor blockers are commonly used medications. With an increased prevalence of cardiovascular (CV) disease worldwide, comes an increased use of CV medications. While relatively uncommon, CV medications toxicity can have significant mortality and morbidity, and necessitates complex management. A 63-year-old male with past medical history of hypertension, benign prostatic hyperplasia, myeloproliferative neoplasm, anxiety, and major depressive disorder presented to our emergency department (ED) for intentional polypharmacy overdose. The patient had severe hypotension and was found to have distributive shock due to acute amlodipine and losartan toxicity. The patient was managed with high dose insulin euglycemia therapy (HIET) with concomitant dextrose infusion and vasopressors in the intensive care unit. HIET is a treatment primarily used for severe toxicity caused by calcium channel blocker or beta-blocker overdoses, it works by improving myocardial contractility and increasing cardiac output through insulin's inotropic effects. Combined CCB and ARB toxicity can lead to very severe hypotension and hemodynamic instability. Several treatment options are available, with the first-line options being HIET, vasopressors, and calcium. • Cardiovascular medications account for around 119,000 of all toxicity cases yearly. • The most common symptoms of toxicity are hypotension, bradycardia and shock. • Combined CCB and ARB toxicity can lead to very severe hemodynamic instability. • High-dose insulin euglycemia therapy improves myocardial contractility. • Very close monitoring of hemodynamics, electrolytes and glucose levels is required.