Delayed Non-Cardiogenic Pulmonary Edema After Amlodipine Overdose: A Case Highlighting Atypical Complications
Year: 2026
Type: conference-abstract
Abstract: Introduction: Calcium channel blocker (CCB) overdose typically presents with early hypotension and bradycardia. This case highlights an unusual delayed complication in a 21-year-old female with iron deficiency anemia, depression, and connective tissue disease who intentionally ingested 100 mg of amlodipine. Case Presentation: The patient presented 2 hours post-ingestion with dizziness, hypotension (98/57 mmHg), tachycardia (HR 103 bpm), and mild fever (37.7°C). Initial management included IV calcium gluconate and hydration. Unexpectedly, 20 hours later, she developed acute hypoxemia and dyspnea. Imaging revealed bilateral pulmonary infiltrates, pleural effusions, atelectasis, and B-lines on ultrasound, with preserved ejection fraction. NT-proBNP escalated sharply (46 → 1701 → 2002 pg/mL). She was managed with diuretics, steroids, and high-flow nasal cannula (HFNC) oxygen, with suspected non-cardiogenic pulmonary edema. Key Learning Points: Atypical Delayed Complication: CCB overdose may precipitate late-onset non-cardiogenic pulmonary edema despite initial hemodynamic stabilization. Role of Biomarkers & Imaging: Rising NT-proBNP with preserved EF suggests non-cardiac strain; lung ultrasound and CXR are critical for diagnosing pulmonary complications. Multi-Modal Management: Combination therapy (diuretics + steroids) and advanced respiratory support (HFNC) may be necessary for pulmonary edema refractory to standard CCB overdose protocols. Risk Factors: Underlying connective tissue disease may potentiate inflammatory lung injury in toxin-mediated insults. Conclusion: This case underscores the need for extended monitoring beyond 24 hours in CCB overdose and demonstrates that pulmonary edema, driven by inflammatory mechanisms rather than cardiac failure, can be a delayed life-threatening complication.
Authors: KAM HANG LEONG, HOI IP LEONG, Tam Fei Chang
Institution: Hospital Conde S. Januário
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7204197870