Life-Threatening Amlodipine Overdose: A Rare Case of Noncardiogenic Pulmonary Edema and Respiratory Failure Requiring ICU Care.

Amlodipine, a dihydropyridine calcium channel blocker (CCB), is commonly prescribed for hypertension and anginal chest pain. An overdose of this medication can result in life-threatening complications such as vasodilatory shock and pulmonary edema. Noncardiogenic pulmonary edema in this setting is rare and not well understood. We report the case of a 57-year-old female with a complex medical history, including diffuse large B-cell lymphoma (DLBCL) in remission, asthma, and depression, who presented after ingesting approximately 87 tablets (870 mg) of amlodipine in a suicide attempt. The patient developed distributive shock requiring vasopressor support and acute hypoxic respiratory failure due to noncardiogenic pulmonary edema requiring intubation, mechanical ventilation, and intensive care unit (ICU) admission. Her course was complicated by prolonged mechanical ventilation and ventilator-associated pneumonia (VAP), acute kidney injury (AKI), and metabolic derangements. With aggressive supportive therapy-including vasopressors, diuresis, antibiotics, and mechanical ventilation-the patient made a full recovery. This case is notable because NCPE is an uncommon manifestation of amlodipine toxicity [5], and because the patient survived despite multiple comorbidities. Early recognition and multidisciplinary management are critical to survival.