Abstract
We report a case of acute renal failure in a patient with labetalol overdose, discuss the possible pathogenesis, and highlight special considerations in the management of labetalol overdose as compared with other beta-blocking agent overdoses.
Highlights
Acute renal failure is uncommon in pure beta adrenergic blocker toxicity, but labetalol, with its alpha blockade, can lead to complex hemodynamic changes and can cause acute renal failure at toxic levels
With prolonged hypotension and ischemic acute renal failure, it is postulated that the kidneys lose their ability of auto-regulation via the renin angiotensin system; in beta-blocker overdose, there is uninterrupted alpha stimulation, leading to efferent arteriole vasoconstriction, and, so, maintenance of intraglomerular pressures, which helps to maintain the glomerular filtration rate and avoid uremia [5]
With cases involving labetalol overdose, the alpha receptor antagonism will lead to efferent arteriole vasodilatation and a fall in the intraglomerular pressure; there is a reduction in the glomerular filtration rate
Summary
Acute renal failure is uncommon in pure beta adrenergic blocker toxicity, but labetalol, with its alpha blockade, can lead to complex hemodynamic changes and can cause acute renal failure at toxic levels. A 38-year-old female patient was transferred to our tertiary care center from another hospital with an overdose of approximately 12-14 grams of labetalol with alcohol. After three-four hours, her urine output and blood pressure improved, so norepinephrine was discontinued, and she was transferred to our center. Upon arrival at our center, she was six hours post-ingestion and was on dopamine only Her blood pressure was 84/37; she remained alert and was in no acute distress. Acute tubular necrosis is the possible diagnosis but as the patient was asymptomatic and non-oliguric, a renal biopsy was not performed She was asymptomatic throughout her stay and maintained good urine output. She did not keep her two-week follow-up appointment
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