Antihypertensive Drugs Overdose_ Recognition and Management

Antihypertensive Drugs Overdose: Recognition and Management

Antihypertensive drug overdose can be a serious medical emergency, potentially leading to severe hypotension, organ dysfunction, and even death if not recognized and treated promptly. Understanding the signs, symptoms, and management of overdoses for different classes of antihypertensive medications is crucial for healthcare providers.

General Signs and Symptoms of Antihypertensive Overdose:

Hypotension

Bradycardia or tachycardia (depending on the drug class)

Dizziness, lightheadedness

Syncope

Altered mental status

Weakness, fatigue

Nausea, vomiting

Electrolyte imbalances

Specific Overdose Presentations and Management by Drug Class:

Beta-Blockers:

Signs: Severe bradycardia, hypotension, bronchospasm, hypoglycemia

Management:

Activated charcoal if recent ingestion

Atropine for bradycardia

Glucagon: 5-10 mg IV bolus, followed by infusion

High-dose insulin therapy with glucose

Vasopressors (e.g., epinephrine, norepinephrine) for refractory hypotension

Consider lipid emulsion therapy for severe cases

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Calcium Channel Blockers (CCBs):

Signs: Hypotension, bradycardia (non-dihydropyridines), heart block, hyperglycemia

Management:

Activated charcoal if recent ingestion

Calcium chloride or gluconate IV

High-dose insulin therapy with glucose

Glucagon

Vasopressors for refractory hypotension

Consider lipid emulsion therapy for severe cases

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ACE Inhibitors and ARBs:

Signs: Hypotension, acute kidney injury, hyperkalemia

Management:

Fluid resuscitation

Vasopressors if needed

Monitor and correct electrolyte imbalances

Consider dialysis for severe cases or significant renal impairment

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Diuretics:

Signs: Hypovolemia, electrolyte imbalances (especially hypokalemia, hyponatremia)

Management:

Fluid and electrolyte replacement

Monitor renal function and electrolytes closely

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Alpha-Blockers:

Signs: Severe orthostatic hypotension, reflex tachycardia

Management:

Fluid resuscitation

Vasopressors (preferably alpha-agonists like phenylephrine)

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Centrally Acting Agents (e.g., Clonidine):

Signs: Initial hypertension followed by hypotension, bradycardia, CNS depression

Management:

Supportive care

Atropine for bradycardia

Vasopressors if needed

Naloxone may partially reverse effects in some cases

General Approach to Antihypertensive Overdose:

Assess and stabilize airway, breathing, and circulation

Obtain vital signs, including orthostatic measurements

Perform focused physical examination

Obtain 12-lead ECG

Initiate cardiac monitoring

Establish IV access

Order relevant laboratory tests (electrolytes, renal function, glucose, drug levels if applicable)

Consider activated charcoal for recent ingestions (within 1-2 hours) if airway is protected

Initiate specific treatments based on the drug(s) involved

Consult with poison control center or toxicology service

Admit to appropriate level of care (often ICU) for monitoring and continued management

Key Considerations:

Mixed overdoses are common and may complicate presentation and management