What is the best treatment for acute calcium channel blocker overdose

摘要: When it was introduced in the United States 1982, verapamil a welcome new drug for treatment of supraventricular tachycardia, and other calcium channel blockers soon found wide use managing hypertension, angina pectoris, heart failure, migraine headache. Unfortunately, before long apparent that these wonder drugs had dark side: profound cardiotoxic effects overdose, with narrow gap between therapeutic toxic doses. Calcium antagonists affect every aspect cardiac “plumbing” system: they can abolish sinus node activity atrioventricular conduction, depress force contraction, slacken vascular tone, making them “triple threat” to output vital organ perfusion. Although number cases reported American Association Poison Control Centers has decreased recent years, still account more than 2,000 hospitalizations centers each year, 2011, 90 patients experienced major outcomes 26 died. An acute blocker overdose sends chill up spine most toxicologists because we know how difficult be treat patients. A small dose mean big problems, children suspected ingestion even single tablet some may require ICU observation 24 hours. Ingestion modified-release preparation (SR, XL, etc) delay onset prolong duration symptoms, tablets are too sucked out hefty orogastric tube. To prevent systemic absorption after massive means early, aggressive administration charcoal whole bowel irrigation, if measures started early blocker–induced ileus occurs. It is not surprising poisoning this serious would subject numerous articles medical literature, list potential interventions blocker– induced shock, including calcium, glucagon, various catecholamines, amrinone, sodium bicarbonate, insulin, lipid emulsion. We fair amount about according animal studies human case reports, but c