Haemadsorption therapy for calcium channel blocker overdose

A male patient in his twenties was admitted into the Intensive Care Unit (ICU), following an overdose with an unknown quantity of risperidone (atypical antipsychotic) and a dihydropyridine calcium channel blocker (amlodipine). Resuscitation and supportive care were administered, but hypotension did not resolve despite the administration of intravenous fluids, infusions of calcium, adrenaline, and hyperinsulinemic-euglycemic therapy (HIE). Methylene blue was then administered to maintain the mean arterial pressures. However, the haemodynamic effect was short-lived and did not allow the weaning of the adrenaline. Drug clearance using hemoperfusion/haemadsorption with a styrene resin filter was attempted next. During the two hemoperfusion sessions, each of 6 hours duration, and 24 hours apart, the patient was successfully weaned off all supportive measures and later discharged home. Significant amlodipine concentrations were detected in blood aspirated from both haemadsorption filters at the end of each session.