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Acute pancreatitis after nifedipine and acetaminophen poisoning — case report

  • Case Report
  • Published:
Central European Journal of Medicine

Abstract

The incidence of drug-induced pancreatitis is rare. There have been several reports of acute pancreatitis as a complication in acute poisoning with drugs or toxins. We present a case of a young woman with acute pancreatitis secondary to an overdose of nifedipine and acetaminophen in a suicide attempt. We excluded other causes of acute pancreatitis by clinical history, serum toxicology, serology, and abdominal imaging. The most likely underlying pathophysiological mechanism was ischemic injury of the pancreas secondary to severe collapse induced by nifedipine and possible acetaminophen-induced direct pancreatotoxicity. The pancreatitis resolved with treatment that included continuous veno-venous haemofiltration in an intensive care unit. Emergency and intensive care units should be aware of this unusual complication of such poisoning. To our knowledge, this is the first reported association between massive nifedipine overdose and acute pancreatitis.

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References

  1. Kaurich T. Drug-induced acute pancreatitis. Proc (Bayl Univ Med Cent) 2008; 21(1): 77–81

    Google Scholar 

  2. Badalov N, Baradarian R, Iswara K, Li J, Steinberg W, Tenner S. Drug-induced acute pancreatitis: an evidence-based review. Clin Gastroenterol Hepatol. 2007; 5:648–661

    Article  PubMed  Google Scholar 

  3. Eltookhy A, Pearson NL. Drug-induced pancreatitis. Can Pharmacists J 2006; 139(6): 58–60

    Google Scholar 

  4. Trivedi CD, Pitchumoni CS. Drug-induced pancreatitis: an update. J Clin Gastroenterol 2005; 39:709–716

    Article  PubMed  Google Scholar 

  5. Schmidt LE, Dalhoff K. Hyperamylasaemia and acute pancreatitis in paracetamol poisoning. Aliment Pharmacol Ther 2004; 20: 173–179

    Article  PubMed  CAS  Google Scholar 

  6. Doyon S, Klein-Schwartz W. Hepatotoxicity despite early administration of intravenous N-acetylcysteine for acute acetaminophen overdose. Acad Emerg Med. 2009; 16(1): 34–39

    Article  PubMed  Google Scholar 

  7. Mallick S. Metformin induced acute pancreatitis precipitated by renal failure. Postgrad Med J 2004; 80: 239–240

    Article  PubMed  CAS  Google Scholar 

  8. Harris NS. Case 24-2006: A 40-Year-Old Woman with Hypotension after an Overdose of Amlodipine. N Engl J Med 2006; 355: 602–611

    Article  PubMed  CAS  Google Scholar 

  9. Feierman DE. The effect of paracetamol (acetaminophen) on fentanyl metabolism in vitro. Acta Anaesthesiol Scand. 2000; 44(5): 560–563

    Article  PubMed  CAS  Google Scholar 

  10. Dimova S, Koleva M, Rangelova D, Stoythchev T. Effect of nifedipine, verapamil, diltiazem and trifluoperazine on acetaminophen toxicity in mice. Arch Toxicol. 1995; 70(2): 112–118

    Article  PubMed  CAS  Google Scholar 

  11. Manjuck J, Zein J, Carpati C, Astiz M. Clinical significance of increased lipase levels on admission to the ICU. Chest 2005; 127: 246–250

    Article  PubMed  CAS  Google Scholar 

  12. Sakorafas GH, Tsiotos GG, Sarr MG. Ischemia/reperfusion-induced pancreatitis. Dig Surg 2000;17: 3–14

    Article  PubMed  CAS  Google Scholar 

  13. Pezzilli R, Morselli-Labate AM, Romboli E, Dibenedetti F, Massa M, Migliori M, et al. Pancreatic involvement during the early phase of shock. JOP. J Pancreas (Online) 2002; 3(4): 139–143

    Google Scholar 

  14. Schmidt LE, Dalhoff K. Hyperamylasaemia and acute pancreatitis in paracetamol poisoning. Aliment Pharmacol Ther 2004; 20: 173–179

    Article  PubMed  CAS  Google Scholar 

  15. Banks PA, Freeman ML, and the Practice Parameters Committee of the American College of Gastroenterology. Practice Guidelines in Acute Pancreatitis. Am J Gastroenterol 2006; 101:2379–2400

    Article  PubMed  Google Scholar 

  16. Zhu AJ, Shi JS, Sun XJ. Organ failure associated with severe acute pancreatitis. World J Gastroenterol 2003; 9(11): 2570–2573

    PubMed  Google Scholar 

  17. Beger HG, Rau BM. Severe acute pancreatitis: clinical course and management. World J Gastroenterol 2007; 13(38): 5043–5051

    PubMed  Google Scholar 

  18. Pupelis G, Plaudis H, Grigane A, Zeiza K, Purmalis G. Continuous veno-venous haemofiltration in the treatment of severe acute pancreatitis: 6-year experience. HPB, 2007; 9: 295–301

    Article  PubMed  CAS  Google Scholar 

  19. Lionte C, Sorodoc L, Sorodoc V, Petris OR, Buga C, Ciuhodaru L, et al. Successful treatment of an acute poisoning with meprobamate, amobarbital, propranolol and nifedipin using continuous venovenous hemofiltration — case report. Timisoara Medical Journal 2006; 56(suppl.2): 475–478

    Google Scholar 

  20. Słomka M, Celiński K, Wargocki J, Kleinrok Z, Czerny K, Cichoz-Lach H. The influence of nifedipine (calcium channel blocker) and Bay-K-8644 (calcium channel agonist) on the development of experimental acute pancreatitis. Ann Univ Mariae Curie Sklodowska [Med]. 2001; 56:29–34

    Google Scholar 

  21. Prat F, Amaris J, Ducot B, Bocquentin M, Fritsch J, Choury AD, et al. Nifedipine for prevention of post-ERCP pancreatitis: a prospective, double-blind randomized study. Gastrointest Endosc. 2002;56(2): 202–208

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, School of Medicine, “Gr.T.Popa” University of Medicine and Pharmacy, No. 16 Universitatii Street, 700115, Iasi, Romania

    Laurentiu Sorodoc, Catalina Lionte, Cristina Bologa & Victorita Sorodoc

  2. Department of Nursing, School of Medicine, “Gr.T.Popa” University of Medicine and Pharmacy, No. 16 Universitatii Street, 700115, Iasi, Romania

    Ovidiu Petris

  3. “Sf.Ioan” Emergency Clinic Hospital, No.2 Gen. Berthelot Street, 700483, Iasi, Romania

    Laurentiu Sorodoc, Catalina Lionte, Cristina Bologa, Ovidiu Petris, Victorita Sorodoc & Carmen Buga

Authors
  1. Laurentiu Sorodoc
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  2. Catalina Lionte
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  3. Cristina Bologa
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  4. Ovidiu Petris
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  5. Victorita Sorodoc
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  6. Carmen Buga
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Corresponding author

Correspondence to Catalina Lionte.

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Sorodoc, L., Lionte, C., Bologa, C. et al. Acute pancreatitis after nifedipine and acetaminophen poisoning — case report. cent.eur.j.med 4, 527–531 (2009). https://doi.org/10.2478/s11536-009-0057-y

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  • DOI: https://doi.org/10.2478/s11536-009-0057-y

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