Vasoplegia and pulmonary edema in mixed overdose of antihypertensive drugs: a case report

Pulmonary edema has been considered a rare complication that can occur in the early phase of circulatory compensation in dihydropyridine overdose. Here, we present the case of a previously healthy adolescent with distributive shock secondary to supratherapeutic ingestion of amlodipine, enalapril, and atorvastatin. Twelve hours after ingestion, she developed refractory vasoplegia despite conventional vasopressor management. The patient received methylene blue and single-pass albumin dialysis as additional therapeutic measures. Improvement in the hemodynamic pattern began two hours after the initiation of this therapy and coincided with the onset of dyspnea, crackles, and hypoxemia consistent with pulmonary edema. The treatment of this complication was performed with positive pressure, and on the tenth day, she was discharged without complications. With this case report, we aim to highlight that pulmonary edema can be a potentially life-threatening complication, often underdiagnosed in calcium channel blocker intoxication.