JAIN NIKHILESH, DNB (Med) MRCPI IDCCM
Director and Operational Head Dept of Critical Care Services
CHL Hospitals Indore India, India
Disclosure information not submitted.
VOHRA RUBINA, MD (Med) DM (Nephro)
Consultant Nephrologist
CHL Hospitals Indore India
indore, Madhya Pradesh, India
Disclosure information not submitted.
Title: Telmisartan Amlodipine combination overdose. A first of its kind??
Case Report Body:
Background: Amlodipine overdose with a suicidal intent has been well documented in the literature and this is an era of combination pills for better patient compliance. This communication delineates a case of combination pill overdose (Telmisartan+ Amlodipine) which was treated successfully. On literature search we did not find a documentation of similar case earlier.
Case Report: A 54 year/male presented with a history of consumption of thirty tablets of Telmisartan/ Amlodipine combination (40/5 mg) with a suicidal intent. He was a background hypertensive on treatment with the same tablets. On examination at baseline, he had a GCS of 15/15 with normal hemodynamics. He was put under observation with supportive and symptomatic treatment including Glucagon, Calcium and whole bowel irrigation as we did not find any specific references for treatment of Telmisartan overdose. However, he started deteriorating after three hours and went on to develop severe hypotension, altered sensorium and oliguria along with acute kidney injury (AKI). His hematological parameters were non-contributory. As there were no prior references for treating such a combination overdose and as both the drugs are lipid soluble with a high volume of distribution this patient was subjected to hemoperfusion with hemodialysis with appropriate heparinization and Adsorba charcoal cartridge with a prior informed consent. He was given two sessions with the above and his hemodynamics and clinical status improved significantly. He was weaned off pressors, sensorium achieved normalcy with a GCS of 15/15 and complete reversal of AKI was achieved. He was discharged after five days of hospital stay and remains stable on six months follow up.
Conclusion: This communication documents a successful therapy for a combination overdose of Telmisartan Amlodipine tablets. As we did not come across similar case reports in literature this is probably the first case reported in the aforementioned context.