ACE Inhibitor Overdose

Although not the "usual" method of ingestion-related suicide attempts, ingesting large amounts of ACE inhibitors has been the method chosen by some.  As you might expect, this results in very significant hypotension, and, if not treated, death.

We can reverse benzodiazepines and opiods, but what about ACE inhibitors? Believe it or not, narcan (naloxone) can reverse the hypotension!  The mechanism of action as to how this is accomplished has not fully been elucidated, but it seems to be that ACE inhibitors do act on the brain in some way and not just the angiotensin system. 

Supportive treatment is also very important.  We must keep the patient adequately hydrated and the gut decontaminated.  Although we don't fully understand how narcan reverses ACE inhibitor overdose, we do know that it does.  It doesn't hurt to try it prior to starting pressor agents.