Calcium channel blocker toxicity - Revision history

Rossdonaldson1: /* Management */

2026-04-15T16:57:35Z

Management

← Revisión anterior		Revisión del 16:57 15 abr 2026
Línea 56:		Línea 56:
	''The majority of literature on calcium channel blocker overdose management is low-quality evidence and high-dose insulin and extracorporeal life support have the best evidence; other therapies include calcium, dopamine, norepinephrine, and lipid emulsion therapy may be beneficial but are poorly studied<ref>St-Onge M, et al. Treatment for calcium channel blocker poisoning: a systematic review. Clin Toxicol 2014 [http://informahealthcare.com/doi/pdf/10.3109/15563650.2014.965827 PDF]</ref>		''The majority of literature on calcium channel blocker overdose management is low-quality evidence and high-dose insulin and extracorporeal life support have the best evidence; other therapies include calcium, dopamine, norepinephrine, and lipid emulsion therapy may be beneficial but are poorly studied<ref>St-Onge M, et al. Treatment for calcium channel blocker poisoning: a systematic review. Clin Toxicol 2014 [http://informahealthcare.com/doi/pdf/10.3109/15563650.2014.965827 PDF]</ref>

			===General Approach===
	*Monotherapy only successful for trivial overdoses		*Monotherapy only successful for trivial overdoses

Testtranslate: /* Atropine */

2026-04-15T11:27:40Z

Atropine

← Revisión anterior		Revisión del 11:27 15 abr 2026
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	===[[Atropine]]===		===[[Atropine]]===
	*Adult: 0.5-1mg IV q2-3min to max of 3g		*Adult: 0.5-1mg IV q2-3min to max of 3mg
	*Ped: 0.02mg/kg (minimum is 0.1mg)		*Ped: 0.02mg/kg (minimum is 0.1mg)
	*Administer to anyone with symptomatic [[bradycardia]]		*Administer to anyone with symptomatic [[bradycardia]]

Danbot: Add MedicationDose SMW annotations (8 entries: insulin, calcium gluconate, calcium chloride, norepinephrine, atropine, glucagon, intralipid); dosing verified per ACMT/toxicology guidelines

2026-03-20T16:30:07Z

Add MedicationDose SMW annotations (8 entries: insulin, calcium gluconate, calcium chloride, norepinephrine, atropine, glucagon, intralipid); dosing verified per ACMT/toxicology guidelines

@@ Línea 111: / Línea 111: @@
 *Discharge if asymptomatic x 6-8hrs
 ==See Also==
 *[[Calcium Channel Blockers]]

Rossdonaldson1: /* Video */

2024-04-17T20:11:22Z

Video

← Revisión anterior		Revisión del 20:11 17 abr 2024
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	==External Links==		==External Links==
	*[http://www.emdocs.net/em3am-calcium-channel-blocker-toxicity/ emDocs - Calcium Channel Blocker Toxicity]		*[http://www.emdocs.net/em3am-calcium-channel-blocker-toxicity/ emDocs - Calcium Channel Blocker Toxicity]

	~~==Video==~~
	~~{{#widget:YouTube\|id=twKMOXaH2dE}}~~

	==References==		==References==

Blsimpso at 03:12, 1 July 2021

2021-07-01T03:12:27Z

← Revisión anterior		Revisión del 03:12 1 jul 2021
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	==See Also==		==See Also==
	*[[Calcium Channel Blockers]]		*[[Calcium Channel Blockers]]

			==External Links==
			*[http://www.emdocs.net/em3am-calcium-channel-blocker-toxicity/ emDocs - Calcium Channel Blocker Toxicity]

	==Video==		==Video==

Rossdonaldson1: /* Management */

2019-12-10T06:07:51Z

Management

@@ Línea 66: / Línea 66: @@
 ===[[IV fluids]]===
 *Initial 20cc/kg bolus especially if source of hypotension is undifferentiated and also possibly hypovolemic or due to [[Sepsis]]
 ===[[Atropine]]===
@@ Línea 84: / Línea 105: @@
 *5mg IV bolus q10min x 2
 *will often cause severe [[nausea/vomiting]], give [[Zofran]] prior
 ==Disposition==

Rossdonaldson1: /* Management */

2019-12-10T06:06:25Z

Management

← Revisión anterior		Revisión del 06:06 10 dic 2019
Línea 54:		Línea 54:

	==Management==		==Management==
	''The majority of literature on calcium channel blocker overdose management is low-quality evidence and high-dose insulin and extracorporeal life support have the best evidence; other therapies ~~such as~~ include calcium, dopamine, norepinephrine, and lipid emulsion therapy may be beneficial but are poorly studied<ref>St-Onge M, et al. Treatment for calcium channel blocker poisoning: a systematic review. Clin Toxicol 2014 [http://informahealthcare.com/doi/pdf/10.3109/15563650.2014.965827 PDF]</ref>		''The majority of literature on calcium channel blocker overdose management is low-quality evidence and high-dose insulin and extracorporeal life support have the best evidence; other therapies include calcium, dopamine, norepinephrine, and lipid emulsion therapy may be beneficial but are poorly studied<ref>St-Onge M, et al. Treatment for calcium channel blocker poisoning: a systematic review. Clin Toxicol 2014 [http://informahealthcare.com/doi/pdf/10.3109/15563650.2014.965827 PDF]</ref>

	*Monotherapy only successful for trivial overdoses		*Monotherapy only successful for trivial overdoses

Mtjordan91: /* Background */

2019-11-20T20:14:20Z

Background

← Revisión anterior		Revisión del 20:14 20 nov 2019
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	*Precipitous deterioration is common (esp with verapamil)		*Precipitous deterioration is common (esp with verapamil)
	*[[Nifedipine]] can kill a child with a single pill		*[[Nifedipine]] can kill a child with a single pill
			*Onset of toxicity after overdose is usually seen within the first one to six hours for most CCBs, however verapamil is often more delayed

	===2 Classes===		===2 Classes===
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	*[[Verapamil]], [[Diltiazem]]		*[[Verapamil]], [[Diltiazem]]
	*Stronger effect on heart, weak vasodilators		*Stronger effect on heart, weak vasodilators
	*Toxicity = [[Bradycardia]], decreased inotropy		*Toxicity = [[Bradycardia]], decreased inotropy, [[hypotension]]

	==Clinical Features==		==Clinical Features==
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	**[[Lethargy]], [[confusion]], [[coma]]		**[[Lethargy]], [[confusion]], [[coma]]
	*Metabolic		*Metabolic
	**[[Hyperglycemia]] (inhibits insulin release from pancreatic islet cells)		**[[Hyperglycemia]]
			***CCB inhibits insulin release from pancreatic islet cells leading to decreased glucose uptake in the myocardium
	***Helps to differentiate from [[Beta-Blocker Toxicity]]		***Helps to differentiate from [[Beta-Blocker Toxicity]]
			***Correlates with severity of overdose and poor outcomes

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*[[ECG]]		*Serial [[ECG]]
	**PR prolongation (varying degrees of AV block)		**PR prolongation (varying degrees of AV block)
	***[[AV block]] occurs more commonly with verapamil		***[[AV block]] occurs more commonly with verapamil
	**[[Bradycardia\|Bradyarrhythmia]]		**[[Bradycardia\|Bradyarrhythmia]]
			**Less common presentations include ventricular dysrhythmias and QRS widening, which are more commonly seen in toxicity of membrane-stabilizing beta-blockers (i.e. propranolol)
	*Glucose		*Glucose
	**[[hyperglycemia]], may help distinguish [[β-blocker toxicity]]		**[[hyperglycemia]], may help distinguish [[β-blocker toxicity]]
	*Chemistry		*Chemistry
	**Serum calcium is often normal		**Serum calcium is often normal
			**It is the effect on intracellular calcium in the myocardium and smooth muscle that leads to the toxicity of CCBs
			*Continuous cardiac monitoring

	==Management==		==Management==

ClaireLewis at 14:30, 19 October 2019

2019-10-19T14:30:02Z

← Revisión anterior		Revisión del 14:30 19 oct 2019
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	**PR prolongation (varying degrees of AV block)		**PR prolongation (varying degrees of AV block)
	***[[AV block]] occurs more commonly with verapamil		***[[AV block]] occurs more commonly with verapamil
	**[[Bradyarrhythmia]]		**[[Bradycardia\|Bradyarrhythmia]]
	*Glucose		*Glucose
	**[[hyperglycemia]], may help distinguish [[β-blocker toxicity]]		**[[hyperglycemia]], may help distinguish [[β-blocker toxicity]]

ClaireLewis at 03:15, 24 September 2019

2019-09-24T03:15:18Z

← Revisión anterior		Revisión del 03:15 24 sep 2019
Línea 1:		Línea 1:
	==Background==		==Background==
	*Hemodialysis is ineffective		*[[Hemodialysis]] is ineffective
	*Precipitous deterioration is common (esp with verapamil)		*Precipitous deterioration is common (esp with verapamil)
	*[[Nifedipine]] can kill a child with a single pill		*[[Nifedipine]] can kill a child with a single pill
Línea 8:		Línea 8:
	*[[Nifedipine]], [[Amlodipine]], [[Nicardipine]]		*[[Nifedipine]], [[Amlodipine]], [[Nicardipine]]
	**Systemic vasodilation, mild effect on heart		**Systemic vasodilation, mild effect on heart
	*Toxicity = Hypotension, reflex tachycardia		*Toxicity = [[Hypotension]], reflex [[tachycardia]]
	*With higher doses of toxicity peripheral selectivity is lost		*With higher doses of toxicity peripheral selectivity is lost
	**I.e. may see decreased ~~inotrophy~~, bradycardia		**I.e. may see decreased inotropy, [[bradycardia]]

	====Non-dihydropyridines====		====Non-dihydropyridines====
	*[[Verapamil]], [[Diltiazem]]		*[[Verapamil]], [[Diltiazem]]
	*Stronger effect on heart, weak vasodilators		*Stronger effect on heart, weak vasodilators
	*Toxicity = Bradycardia, decreased inotropy		*Toxicity = [[Bradycardia]], decreased inotropy

	==Clinical Features==		==Clinical Features==
Línea 24:		Línea 24:
	**[[CHF]]		**[[CHF]]
	*Pulmonary		*Pulmonary
	**Respiratory depression		**[[Respiratory arrest\|Respiratory depression]]
	**[[Pulmonary edema]]		**[[Pulmonary edema]]
	*GI		*GI
	**[[Nausea/vomiting]]		**[[Nausea/vomiting]]
	*Neurologic		*Neurologic
	**Lethargy, [[confusion]], [[coma]]		**[[Lethargy]], [[confusion]], [[coma]]
	*Metabolic		*Metabolic
	**[[Hyperglycemia]] (inhibits insulin release from pancreatic islet cells)		**[[Hyperglycemia]] (inhibits insulin release from pancreatic islet cells)
Línea 41:		Línea 41:
	**PR prolongation (varying degrees of AV block)		**PR prolongation (varying degrees of AV block)
	***[[AV block]] occurs more commonly with verapamil		***[[AV block]] occurs more commonly with verapamil
	**[[~~Bradyarrythmia~~]]		**[[Bradyarrhythmia]]
	*Glucose		*Glucose
	**hyperglycemia, may help distinguish β-blocker toxicity		**[[hyperglycemia]], may help distinguish [[β-blocker toxicity]]
	*Chemistry		*Chemistry
	**Serum calcium is often normal		**Serum calcium is often normal