Wei Lina, Li Ping, Yang Xue, Fu Lei, Cheng Cheng, Sun Wei
A 60-year-old male patient with chronic renal failure accompanied by renal hypertension received long-term treatment with amlodipine 10 mg (orally, once daily), captopril 37.5 mg ( orally, thrice daily), and regular hemodialysis (thrice weekly), and his blood pressure was maintained in the range of 150-160/60-70 mmHg. The patient went to the drugstore to buy medicine and the pharmacy clerk sold carbamazepine to him in mistaken for captopril. The patient had taken carbamazepine for 3 days when he found the medication error. Carbamazepine was discontinued by the patient and only amlodipine was taken regularly. Twelve days after captopril withdrawal, the patient developed dizziness, headache, nausea, and vomiting, and his blood pressure was 200/70 mmHg. Three days later, the patient was diagnosed as malignant hypertension and admitted to hospital because his blood pressure increased to 250/100 mmHg. After admission, the patient was given an infusion pump of sodium nitroprusside (1 mg/ml, pump rate 6-8 ml/h) and oral medicines of valsartan and amlodipine tablets (1 tablet, twice daily), terazosin hydrochloride tablets (4 mg, twice daily), and metoprolol succinate sustained-release tablets (47.5 mg, once daily), and hemodialysis was continued (thrice weekly). On the Sixth day of admission, the infusion pump of sodium nitroprusside was changed to nicardipine (0.6 mg/ml, pump rate 6-11 ml/h). On day 10, the patient′s blood pressure dropped to 150/82 mmHg and oral spironolactone 20 mg thrice daily was added. On day 20, his blood pressure dropped to 124/83 mmHg and then the patient was discharged. At 2 months of follow-up, the patient did not have hypertension again.
