Prolonged Refractory Hypotension following Combined Amlodipine and Losartan Ingestion Responsive to Metaraminol

Table 1

Initial effect of metaraminol boluses.

Time since admission to ED in hours	Metaraminol bolus of 0.5 mg	Systolic	Diastolic	MAP	Pulse
In ED		122	61	81	100
In ED 1 hour after admission		70	40	50	90
Taken from medical SHO clerking 3 hours after admission		75	43	54	96
5 when first seen by ICU		80	50	63	98
5 given metaraminol in boluses at intervals of 5–10 minutes.	0.5 mg + 0.5 mg	72	46	55	99
5:20		110	68	82	89
5 then given calcium gluconate (20 mLs of 10%) followed by glucagon 10 mg as a bolus	0.5 mg + 0.5 mg	125	62	84	100
5:30		120	74	89	86
6		90	50	63	85
7 noradrenaline started here		70	48	55	85
8		75	43	54	85
9		80	48	59	85
10		90	55	67	85
11—admitted to ICU- vasopressin started here along with glucagons infusion		85	47	60	95
12 adrenaline started here		95	50	65	80