Amlodipine and atenolol fixed‐dose combination (FDC) overdoses pose significant clinical challenges due to their synergistic effects on cardiovascular function. We present the case of a 17‐year‐old girl with schizophrenia who intentionally ingested 20 tablets of an FDC containing 5 mg amlodipine and 50 mg atenolol per tablet, resulting in profound hypotension (BP 60/32 mmHg) and metabolic acidosis. Standard interventions, including gastric lavage and crystalloid resuscitation, failed to stabilize her condition, necessitating escalation to vasopressor therapy with norepinephrine, adrenaline, and vasopressin, which led to hemodynamic improvement. Notably, she developed transudative pleural effusions on Day 4, a rare complication of amlodipine overdose, managed effectively with intravenous furosemide and fluid restriction. Additionally, hypocalcemia and hyponatremia emerged during her hospital course, requiring targeted electrolyte replacement. The patient achieved full recovery without the need for high‐dose insulin or glucagon therapy. This case underscores the efficacy of early vasopressor support in severe calcium channel blocker and beta‐blocker overdose and highlights pleural effusion as a rare but treatable complication. Prompt multidisciplinary intervention, including psychiatric care, was essential in ensuring a favorable outcome and preventing recurrence. Further studies are warranted to explore optimal management strategies in such complex toxicological cases.
Ramesh et al. (Thu,) studied this question.
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