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Case Reports
Vasopressor-Refractory Shock From Clozapine Overdose Treated With Synthetic Angiotensin II Infusion.
- Patrick M Wieruszewski, Sarah Nelson, Erica D Wittwer, and Jonathan G Leung.
- Department of Pharmacy, Mayo Clinic, Rochester, MN.
- Crit Care Explor. 2020 Sep 1; 2 (9): e0185.
BackgroundClozapine is an atypical antipsychotic with potent alpha-adrenergic blocking properties when administered at high dosages, resulting in vasodilatory shock in overdose settings.Case SummaryA 39-year-old man presented with profound catecholamine- and vasopressin-refractory vasodilatory shock following massive clozapine ingestion. Angiotensin II was initiated when the patient was requiring 2.2 µg/kg/min norepinephrine equivalents of vasopressor support, resulting in a prompt increase in the perfusion pressure. All vasopressors were liberated within 18 hours of angiotensin II initiation, and the patient was discharged with no deficits.ConclusionsSynthetic angiotensin II may represent a therapeutic option for refractory hypotension resulting from high dosages of clozapine or other potent alpha-adrenergic blocking medications.Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
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