Enalapril Overdose: Clinical Presentation and Treatment Strategies

Posted: March 18th, 2022

ACE Inhibitor Overdose: A Case Study of Hypotension and Management. Analyze the clinical presentation and management of a 33-year-old female presenting with enalapril overdose, focusing on hypotension and treatment strategies

Case Study : ACE Inhibitor Overdose

History:A 33-year-old woman arrives at the emergency department, visibly distressed, with complaints of fever and diarrhea. She tearfully admits to ingesting 20 enalapril tablets approximately 30 minutes before arrival. She insists she is not currently suicidal and has taken no other medications. The pills belonged to her father.

Past Medical History (PMH): None.

Physical Examination:

Temperature: 100.8°F

Heart Rate: 100 bpm

Respiratory Rate: 18 breaths per minute

Blood Pressure: 80/40 mm Hg

General: Awake and alert, but visibly upset.

HEENT: No abnormalities noted.

Pulmonary: Clear breath sounds, no respiratory distress.

Cardiovascular: Regular heart rate and rhythm, no murmurs.

Abdomen: Soft, non-tender.

Neurologic: Cranial nerves II-XII intact, normal muscle strength.

1. What Are the Signs and Symptoms of an ACE Inhibitor Overdose?

Overdosing on ACE inhibitors like enalapril is typically not life-threatening but can lead to several notable symptoms, primarily related to blood pressure regulation and kidney function. The most common symptoms include:

Hypotension (low blood pressure): Can lead to dizziness, fainting, or even shock in severe cases.

Diarrhea and nausea: Gastrointestinal distress is common in overdose scenarios.

Angioedema: Although rare, swelling of the lips, tongue, or throat can occur, leading to potential airway obstruction.

Hyperkalemia (elevated potassium levels): Can cause muscle weakness, irregular heart rhythms, and, in extreme cases, cardiac arrest.

Drug fever and rash: Some patients may experience fever and skin irritation as a reaction to the overdose.

2. How Should the Hypotension Be Managed?

The primary concern in this patient is her low blood pressure (80/40 mm Hg). Management should be tailored to improving circulation and preventing organ damage. The key interventions include:

Positioning: Laying the patient supine with legs elevated to promote blood flow to vital organs.

Intravenous (IV) Fluids: Rapid administration of isotonic saline or lactated Ringer’s solution to restore intravascular volume.

Vasopressors: If fluid resuscitation is insufficient, medications such as norepinephrine or dopamine may be used to maintain blood pressure.

Monitoring: Continuous assessment of blood pressure, heart rate, kidney function, and electrolytes, especially potassium levels.

3. How Do Angiotensin-Converting Enzyme (ACE) Inhibitors Work?

ACE inhibitors function by blocking the conversion of angiotensin I to angiotensin II, a powerful vasoconstrictor responsible for raising blood pressure. By inhibiting this process, ACE inhibitors:

Reduce blood vessel constriction, leading to lower blood pressure.

Decrease sodium and water retention, which helps manage hypertension and heart failure.

Increase bradykinin levels, which can lead to vasodilation but also contribute to side effects such as coughing and angioedema.

Conclusion

This patient’s enalapril overdose has resulted in symptomatic hypotension, requiring immediate fluid resuscitation and careful monitoring. While ACE inhibitor overdoses are usually not fatal, complications like severe hypotension, hyperkalemia, and angioedema must be anticipated and managed accordingly. Given her emotional distress, a psychiatric evaluation should also be considered to ensure her overall well-being.

 

Absolutely! Here’s a breakdown of titles, meta Buy Papers—Online College Essay Hub Writers descriptions, references, and keywords based on the case study:

Titles:

1. ACE Inhibitor Overdose: A Case Study of Hypotension and Management
2. Enalapril Overdose: Clinical Presentation and Treatment Strategies
3. Managing ACE Inhibitor Toxicity: A 33-Year-Old Female Case

Meta Descriptions:

1. Analyze the clinical presentation and management of a 33-year-old female presenting with enalapril overdose, focusing on hypotension and treatment strategies.
2. Discuss the signs, symptoms, and treatment of ACE inhibitor overdose, with a detailed look at a case involving significant hypotension.
3. Construct a comprehensive overview of ACE inhibitor toxicity, including pathophysiology, clinical features, and emergency management protocols.
4. Help understand the clinical implications of ACE inhibitor overdose and the importance of rapid intervention to prevent complications like severe hypotension.

References:

1. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. (2023). Angiotensin-Converting Enzyme Inhibitors. In National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK548981/
2. Lexicomp Online, AHFS Drug Information. (2023). Enalapril. Wolters Kluwer.
3. UpToDate. (2023). ACE inhibitor poisoning. Wolters Kluwer.

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