{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T06:40:24Z","timestamp":1784875224910,"version":"3.55.0"},"reference-count":10,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Asian J Neurosurg"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Nimodipine, a calcium channel blocker of the dihydropyridine class, is used prophylactically in ruptured aneurysmal subarachnoid hemorrhage (aSAH) patients to reduce the incidence of poor outcome, delayed cerebral ischemia, and delayed ischemic neurological deficits. This case series reports nine instances of normal anion gap metabolic acidosis (NAGMA) in patients with aSAH following intravenous nimodipine administration in a neuro-intensive care unit (NICU) over 2 months. The patients, aged 4 to 68 years (seven male, two female), presented with acute headaches and were diagnosed with intracranial aneurysms, managed with aneurysmal clipping or coiling. Intravenous nimodipine (1\u20132\u2009mg\/hour) was initiated as per protocol, along with standard NICU care. After 48 to 72\u2009hours, patients developed hyperventilation, respiratory alkalosis, and a significant decrease in bicarbonate, leading to NAGMA. Despite ruling out common causes like gastrointestinal losses and nephrotoxic drugs, renal tubular acidosis was suspected. The NAGMA resolved spontaneously 6 to 7 days postsurgery, coinciding with the discontinuation of intravenous nimodipine. A retrospective audit revealed a common factor: using a specific brand of intravenous nimodipine, a new arrival from the hospital supply. This phenomenon was later corroborated in a similar case from another hospital. The case highlights the importance of pharmacovigilance, postmarketing surveillance, and regulatory oversight in identifying rare drug-related adverse events, particularly in high-acuity settings like NICU.<\/jats:p>","DOI":"10.1055\/s-0045-1809355","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T19:51:53Z","timestamp":1748289113000},"page":"805-809","source":"Crossref","is-referenced-by-count":2,"title":["Unraveling NAGMA: A Case Series of Intravenous Nimodipine-Induced Metabolic Acidosis in Neuro-ICU Patients"],"prefix":"10.1055","volume":"20","author":[{"given":"Umadevi","family":"Manyam","sequence":"additional","affiliation":[{"name":"Department of Neuroanaesthesiology and Neurocritical Care, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4728-5592","authenticated-orcid":false,"given":"Sivakumar","family":"Ramalingam","sequence":"additional","affiliation":[{"name":"Department of Neuroanaesthesiology and Neurocritical Care, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak","family":"Nandwana","sequence":"additional","affiliation":[{"name":"Department of Neuroanaesthesia and Neurocritical Care, CK Birla Hospital, Jaipur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dineshkumar","family":"Ramanathan","sequence":"additional","affiliation":[{"name":"Department of Neuroanaesthesiology and Neurocritical Care, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun","family":"Chelani","sequence":"additional","affiliation":[{"name":"Department of Neuroanaesthesiology and Neurocritical Care, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9139-0689","authenticated-orcid":false,"given":"Keshav","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Neuroanaesthesiology and Neurocritical Care, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1007\/s12028-022-01493-4","article-title":"A comparison between enteral and intravenous nimodipine in subarachnoid hemorrhage: a systematic review and network meta-analysis","volume":"36","author":"F Geraldini","year":"2022","journal-title":"Neurocrit Care"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"107026","DOI":"10.1016\/j.clineuro.2021.107026","article-title":"Hydroxocobalamin rescue from nimodipine-induced refractory vasoplegia","volume":"211","author":"T M Cooper","year":"2021","journal-title":"Clin Neurol Neurosurg"},{"issue":"10","key":"ref3","doi-asserted-by":"crossref","first-page":"2715","DOI":"10.1007\/s00701-021-04837-9","article-title":"The effect of nimodipine on pulmonary function in artificially ventilated patients with aneurysmal subarachnoid hemorrhage","volume":"163","author":"J Lunkiewicz","year":"2021","journal-title":"Acta Neurochir (Wien)"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1007\/s12028-023-01760-y","article-title":"Blood pressure changes in association with nimodipine therapy in patients with spontaneous subarachnoid hemorrhage","volume":"39","author":"V Rass","year":"2023","journal-title":"Neurocrit Care"},{"key":"ref5","volume-title":"Nimodipine. [Updated 2024 May 7]","author":"J M Das"},{"issue":"07","key":"ref6","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1111\/imj.16418","article-title":"Demystifying normal-anion-gap metabolic acidosis: pathophysiology, aetiology, evaluation and diagnosis","volume":"54","author":"R Bhandari","year":"2024","journal-title":"Intern Med J"},{"key":"ref7","first-page":"F1000","article-title":"Drug-induced metabolic acidosis","volume":"4","author":"A Q Pham","year":"2015","journal-title":"F1000 Res"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1053\/j.ackd.2018.05.003","article-title":"Hypokalemic distal renal tubular acidosis","volume":"25","author":"P G Vall\u00e9s","year":"2018","journal-title":"Adv Chronic Kidney Dis"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"e71","DOI":"10.1016\/j.jemermed.2023.04.012","article-title":"A review of bicarbonate use in common clinical scenarios","volume":"65","author":"G Wardi","year":"2023","journal-title":"J Emerg Med"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"748413","DOI":"10.3389\/fneur.2021.748413","article-title":"Safety and clinical effects of switching from intravenous to oral nimodipine administration in aneurysmal subarachnoid hemorrhage","volume":"12","author":"J G\u00f6ttsche","year":"2021","journal-title":"Front Neurol"}],"container-title":["Asian Journal of Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0045-1809355.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:01:16Z","timestamp":1764720076000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0045-1809355"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,26]]},"references-count":10,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2025,12,2]]},"published-print":{"date-parts":[[2025,12]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0045-1809355","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1793-5482","2248-9614"],"issn-type":[{"value":"1793-5482","type":"print"},{"value":"2248-9614","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,26]]}}}