Calcium channel blocker overdose in real world practice: A case report

Introduction: Calcium channel blocker (CCB) toxicity, particularly from dihydropyridine agents, like amlodipine, can cause life-threatening vasodilatory shock, bradycardia, and metabolic disturbances. In severe cases, standard resuscitative measures may be insufficient, necessitating advanced supportive and targeted therapies. Case Presentation: A 72-year-old male presented 9 h after intentional ingestion of 200 tablets (1000 mg) of amlodipine with hypotension, metabolic acidosis, and acute kidney injury, but without hyperglycemia. Initial management included intravenous fluid resuscitation, calcium gluconate, and vasopressors. Despite this, he developed refractory shock, acute respiratory failure, and cardiac arrhythmia, requiring mechanical ventilation and intensive hemodynamic support. High-dose insulin euglycemia therapy (HIE) and methylene blue were administered. Renal function gradually improved, and vasopressors were weaned, and the patient was successfully extubated and discharged. Conclusion: This case highlights the complexity of managing severe amlodipine overdose, emphasizing the role of early vasopressors, calcium salt administration, and adjunctive therapies such as HIE and methylene blue. Prompt recognition and a multimodal approach are critical for improving outcomes in patients with CCB toxicity.