Calcium Channel Blocker Poisoning/Overdose

Table of Contents

Aliases

Anti-hypertensive

Patient Care Goals

  1. Reduce GI absorption of oral agents with some form of binding agent (activated charcoal) especially for extended release
  2. Early airway protection is required as patients may have rapid mental status deterioration
  3. Assure adequate ventilation, oxygenation and correction of hypoperfusion

Patient Presentation

Calcium channel blockers interrupt the movement of calcium across cell membranes. Calcium channel blockers are used to manage hypertension, certain rate-related arrhythmias, prevent cerebral vasospasm, and angina pectoris. Patients may present with:

  1. Bradycardia
  2. Hypotension
  3. Decreased AV Nodal conduction
  4. Cardiogenic shock
  5. Hyperglycemia

Inclusion Criteria

  1. Patients who have may have taken/been administered calcium channel blockers
    1. Calcium channel blocker examples:
      1. Amlodipine (Norvasc®)
      2. Diltiazem (Cardizem®, Tiazac®)
      3. Felodipine
      4. Isradipine
      5. Nicardipine
      6. Nifedipine (Adalat CC®, Afeditab CR®, Procardia®)
      7. Nisoldipine (Sular®)
      8. Verapamil (Calan®, Verelan®)

Exclusion criteria

No recommendations

Patient Management

Assessment

  1. Assess ABCDs and, if indicated, expose and then cover to assure retention of body heat
  2. Vital signs including temperature
  3. Apply a cardiac monitor, examine rhythm strip for arrhythmias, and consider obtaining a 12-lead EKG
  4. Check blood glucose Level
  5. Monitor pulse oximetry and ETCO2 for respiratory decompensation
  6. Identify specific medication taken (noting immediate release vs. sustained release formulations), time of ingestion, and quantity
  7. Pertinent cardiovascular history or other prescribed medications for underlying disease
  8. Patient pertinent history
  9. Physical exam

Treatment and Interventions

  1. Consider atropine sulfate for symptomatic bradycardia
    1. Adult: atropine 0.5 mg IV every 5 minutes to maximum of 3 mg
    2. Pediatric: atropine 0.02 mg/kg (0.1 to 0.5 mg per dose) every 5 minutes, maximum total dose 1 mg
  2. Consider calcium chloride
    1. Calcium chloride
      1. Adult: Calcium chloride 1 g slow IVP
      2. Pediatric: Calcium chloride 20 mg/kg (0.2 mL/kg) slow IVP/IO. Maximum dose 1 g or 10 mL
  3. Consider IV fluid 20 mL/kg up to 1 liter, repeat as indicated
  4. Consider vasopressors after adequate fluid resuscitation for the hypotensive patient [see Shock guideline for adult vs. pediatric dosing]
  5. If atropine, calcium, and vasopressors have failed in the symptomatic bradycardia patient, consider
    1. Glucagon:
      1. Glucagon 1 mg IVP (Over 25 kg)
      2. Glucagon 0.5 mg IVP (less than 25 kg)
  6. Consider transcutaneous pacing if refractory to initial pharmacologic interventions
  7. If seizure, [see Seizure guideline]

Notes – Calcium Channel Blocker Poisoning/Overdose