Overdose of methyldopa, indapamide and theophylline resulting in prolonged hypotension, marked diuresis and hypokalaemia in an elderly patient.

摘要: An 89-year-old man with a history of hypertension, chronic obstructive pulmonary disease, personality disorder and previous attempts self-poisoning attempted suicide by swallowing two mouthfuls tablets (methyldopa 250 mg, theophylline SR 200 indapamide 2.5 mg paracetamol 500 mg). He had prolonged, severe hypotension, necessitating the use 3000 ml Gelofusine almost 2 days intravenous norepinephrine infusion. marked diuresis for 4.5 days, requiring continuous bolus infusions fluids. renal potassium loss, vigorous replacement therapy. Multiple-dose activated charcoal was used to enhance elimination. The plasma level below treatment line. Methyldopa via its metabolite stimulates postsynaptic alpha-adrenergic receptors in cardiovascular control centres brain, causing reduction peripheral sympathetic tone fall arterial blood pressure heart rate. In overdose, it causes bradycardia drowsiness. natriuretic, kaliuretic vasodilatory effects are exaggerated resulting diuresis, hypokalaemia hypotension. Theophylline markedly increases circulating catecholamines, which stimulate vascular beta(2)-adrenergic decreased resistance. Peripheral vasodilation hypotension occur significant poisoning. Intracellular shift results hypokalaemia. prescribing physicians should recognise elderly patients at high risk avoid using drugs toxicity overdose (e.g. methyldopa). Restricting access hazardous (in overdose) would be paramount importance reduce number acute poisoning cases case-fatalities.