Ugeskr Læger 2017;179:V05170363
Methylene blue against refractory hypotension
In this case report we describe a 62-year-old man, intoxicated with losartan, an angiotensin-II receptor antagonist. The patient presented with a systolic blood pressure of 60 mmHg, metabolic acidosis, and hyperglycaemia. His condition worsened within the first hour of arrival despite infusion of four litres of saline, epinephrine, norepinephrine, and vasopressin as well as insulin and antibiotics. Intravenous methylene blue 75 mg was infused over five minutes. Within 30 minutes his systolic pressure increased to 100 mmHg, and the infusion of epinephrine could be reduced four hours later.