Ciddi Vazoplejik Gelen Bir İntoksikasyon Olgusu
Özet
Amlodipin L tipi "voltaj kapılı" kalsiyum kanalları aracılığıyla kardiyak ve vasküler düz kas hücrelerine kalsiyum girişini inhibe ederek hem arterlerin hem de arteriollerin genişlemesine yol açan bir kalsiyum kanal blokeridir (KKB). Yüksek doz kullanımı derin vazodilatasyon, hipotansiyon ve vazopressöre dirençli şoka sebep olurken ayrıca pankreas adacık hücrelerindeki L tipi kalsiyum kanallarını da inhibe ettiği için insülin sekresyonunu azaltarak hiperglisemiye ve kalpte glukoz kullanımının azalmasına neden olur. Bu olgu sunumunda suisit amaçlı yüksek dozda amlodipin alımı sonrası vazoplejik şok gelişen hastanın yoğun bakım ünitesindeki yönetimi ele alınmıştır.
Amlodipin 30 ila 50 saat arasında uzun bir yarı ömrü olan %97,5'i proteine bağlı olarak taşınan ve oldukça lipofilik bir ilaçtır. Yüksek derecede proteine bağlanma özelliği nedeniyle intoks durumlarından diyalizin fayda göstermediği bilinmektedir. Altın standart bir tedavi yaklaşımı konusunda bir fikir birliği yoktur. Tedavide temel amaç destekleyici bakımın sağlanması, ilaç emiliminin azaltılması ve kardiyotonik ajanlarla kardiyak fonksiyonları arttırılmasıdır. Ciddi vazoplejik şokla yoğun bakım ünitesinde alınan bu hastada erken dönemde verilen destek ve inotropik tedaviye yanıt alınmış hasta iyileşmiştir. Yüksek mortalite ile seyredebilen amlodipin intoksikasyonunda yoğun bakım desteği ve erken destekleyici tedavi yaklaşımı hayat kurtarıcıdır.
Amlodipine is a calcium channel blocker (CCB) that inhibits calcium entry into cardiac and vascular smooth muscle cells via L-type ‘voltage-gated’ calcium channels, leading to dilation of both arteries and arterioles. High doses cause profound vasodilatation, hypotension and vasopressor-resistant shock, and since it also inhibits L-type calcium channels in pancreatic islet cells, it decreases insulin secretion, causing hyperglycemia and decreased glucose use by the heart. In this case report, the management of a patient who developed vasoplegic shock after taking high doses of amlodipine for suicidal purposes in the intensive care unit is discussed.
Amlodipine is a highly lipophilic drug with a long half-life of 30 to 50 hours and 97.5% protein-bound transport. It is known that dialysis is not beneficial in cases of intoxication due to its high degree of protein binding. There is not consensus on a gold standard treatment approach. The main aim of treatment is to provide supportive care, decrease drug absorption and increase cardiac function with cardiotonic agents. This patient who was admitted to the intensive care unit with severe vasoplegic shock responded to early supportive and inotropic treatment and recovered. Intensive care support and early supportive treatment approach is life-saving in amlodipine intoxication, which can be associated with high mortality.
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