Document Type : Original Article

Authors

• Maha Abdelhamied Ghanem ¹
• Manal A Hassan ¹
• Mohamed mostafa Megahed ²
• Esraa El-Sayed Ghoneim ¹
• Sara Attia Ghitani ¹

¹ Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Alexandria University, Egypt

² Intensive Care Unit, Faculty of Medicine, Alexandria University, Egypt

Abstract

Background: Despite different antidotes, antihypertensive toxicity, especially beta-blockers (BB) and calcium channel blockers (CCB), have a significant morbidity and mortality. This study aimed to determine the prevalence and characteristics of antihypertensive toxicity among the admitted patients to Alexandria Poison Center (APC).
Method: A cross-sectional study was carried out on all patients with antihypertensive toxicity, admitted to APC throughout year 2022. The management plan with adding methylene blue (MB) as a single bolus dose of 1mg/kg over 10 min to shocked cases was assessed.  
Results: This work included 105 patients; with a mean age of (23.3 ± 13.3 years), (22.9%) were males and (77.1%) were females. The majority ingested BB and CCB. ECG showed bradycardia (8.6%), prolonged QTC (11.4%), prolonged PR interval (9.5%) and wide QRS complex (1.9%). Of all patients, (8.6%) received atropine, (4.8%) received vasopressors, (7.6%) received intravenous (IV) calcium and (4.8%) received high insulin glucose. In the current work, two cases presented with shock (1.9%) received IV MB early and survived. Refractory shock was the cause of death in (1.9%) of the cases who died before starting MB. The mean length of hospital stay was 34.06 ± 21.42 hours.  Ingestion of antihypertensive agents from different classes and prolonged PR interval were the main predictors of the length of hospital stay where P = 0.012, 0.021 at 95% CI respectively.
Conclusion: Beta-blockers were the commonest ingested antihypertensive agent. Simultaneous ingestion of antihypertensive agents from different classes and prolonged PR interval have a significant prediction of the hospital stay length.

Keywords

• Antihypertensive toxicity
• BB
• CCB
• methylene blue

Main Subjects

• Medical Toxicology