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- Title
A Rare and Life Threatening Intoxication with “ACE Inhibitor-Perindopril” .
- Authors
Yılmaz, Nurdan; Tunay, Burcu; Tandoğan, Neslihan; Akın, Ayşe Nurmen
- Abstract
Introduction: Cardiovascular drugs represent only 4% of all drug poisonings. The use of angiotensin-converter-enzyme inhibitors (ACEIs) in high doses results in hyperkalemia, acute renal failure, and severe hypotension. In this study, it was aimed to discuss in light of the literature a 34-year-old patient who took high doses Coversyl and Coveram tablets® for suicidal purposes. Since there are few reports in the literature regarding combined antihypertensive intoxication, it is important to report such cases. Case: A 34-year-old female patient took 30 Coversyl tablets® (10 mg perindopril), 40 Coveram tablets® (10 mg perindopril arginine + 5 mg amlodipine) with suicidal intent, she presented to the emergency department with complaints of dizziness and weakness. The patient’s general condition was moderate, conscious, oriented, and cooperative. Blood pressure was 40/30 mmHg, pulse rate was 158/min, and filiform, the temperature was 36.8 ˚C, respiratory examination was normal. Despite fluid resuscitation and dopamine infusion in the emergency department, her blood pressure was 50/30 mmHg and she was interned to the intensive care unit. Glucagon and lipid infusion therapy was initiated because he remained hypotensive for a long time despite high dose inotrope infusion. Creatinine increased and urine output decreased. Hemodiafiltration could not be performed due to persistence of deep hypotension and the patient was followed up with fluid resuscitation and furosemide infusion. Discussion: Perindopril, is a prodrug with a half-life of 17 hours, with an effect on blood pressure seen 2-5 hours after ingestion. Hypotension and decreased glomerular filtration due to efferent arteriolar dilatation are the main causes of acute renal failure in ACEI intoxication. Fluid replacement and use of vasoactive agents are preferred in the treatment of hypotension and acute renal failure, and renal failure was treated with the same treatment in our case. Although there is no clear approach to treatment, It is important to present such cases.
- Subjects
ACUTE kidney failure; HYPERKALEMIA; BLOOD pressure; INTENSIVE care units; DRUG toxicity; INFUSION therapy
- Publication
Turkish Journal of Intensive Care, 2023, Vol 21, p29
- ISSN
2146-6416
- Publication type
Case Study