Quinapril Overdose-Induced Renal Failure

Background: Angiotensin converting enzyme (ACE) inhibitor toxicity is infrequently reported and seldom produces significant clinical effects. Only 15 previous cases of intentional ACE inhibitor overdoses among adults have been published. The most commonly observed clinical effect is hypotension, which is typically transitory and responsive to supportive measures and intravenous hydration. An additional 48 pediatric exposures were reported in a single case series, none of which resulted in any adverse effects related to the ACE inhibitors. Reversible impairment in renal function has been reported in 5 cases of ACE inhibitor overdose, but only in association with systemic hypotension (systolic blood pressure < 90 mmHg). We report a case of intentional quinapril overdose where the patient presented two days later with acute renal failure in the absence of clinical features of systemic hypotension. Additionally, this is the first reported case of quinapril overdose of which we are aware.