Calcium Channel Blocker Ingestion: An Evidence-Based Consensus Guideline for Out-of-Hospital Management

Olson, Kent R.; Erdman, Andrew R.; Woolf, Alan D.; Scharman, Elizabeth J.; Christianson, Gwenn; Caravati, E. Martin; Wax, Paul M.; Booze, Lisa L.; Manoguerra, Anthony S.; Keyes, Daniel C.; Chyka, Peter A.; Troutman, William G.

doi:10.1080/15563650500357404

Cited by 77 publications

(85 citation statements)

References 113 publications

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“…A consensus panel recently reviewed the medical literature for toxic doses of β-blockers and CCBs to establish threshold doses for triage and prehospital management of poisonings. 7,8 In general, β-blockers with low lipid solubility that lack membrane-stabilizing effects are much safer than agents that have these effects. [9][10][11] Among CCBs, the newer agents are generally safer than diltiazem or verapamil.…”

Section: Comparison Of Pharmacologic Properties Of Various β-Blockersmentioning

confidence: 99%

“…12 Hyperglycemia is a common finding in cases of CCB poisoning that is not normally seen with therapeutic dosing. 3,8,13 At high doses, CCBs cause a significant decrease in insulin release by blocking calcium influx into pancreatic islet cells. This lack of circulating insulin decreases cardiac carbohydrate metabolism by preventing glucose uptake and use by cardiac muscle (Figure 1).…”

Section: Comparison Of Pharmacologic Properties Of Various β-Blockersmentioning

confidence: 99%

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Treatment of poisoning caused by β-adrenergic and calcium-channel blockers

Shepherd

2006

American Journal of Health-System Pharmacy

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Section: Comparison Of Pharmacologic Properties Of Various β-Blockersmentioning

confidence: 99%

Section: Comparison Of Pharmacologic Properties Of Various β-Blockersmentioning

confidence: 99%

Treatment of poisoning caused by β-adrenergic and calcium-channel blockers

Shepherd

2006

American Journal of Health-System Pharmacy

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“…Calcium channel blocker intoxication is lifethreatening (1). According to the Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS), of the 10,868 cases of toxic calcium channel blocker exposure reported in 2013, 21.5% were treated at health care facilities, 68 involved a major effect and 29 resulted in a lethal outcome (2).…”

Section: Introductionmentioning

confidence: 99%

Ischemic Acute Tubular Necrosis due to Diltiazem Overdose

et al. 2016

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Diltiazem overdose has a high mortality rate due to cardiotoxicity associated with bradycardia and hypotension. A previous article reported that this type of overdose can cause acute tubular necrosis, which was not pathologically, but rather clinically, diagnosed. We herein report the case of a 55-year-old man who sustained nonoliguric acute kidney injury after taking 60 diltiazem tablets. A kidney biopsy performed six days after admission showed ischemic, not toxic, acute tubular necrosis. The patient's kidney function improved spontaneously. In this case report, we clarify the cause of renal impairment caused by diltiazem overdose pathologically. Physicians should therefore consider ischemic acute tubular necrosis as a cause of kidney injury in patients with diltiazem overdose.

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“…The following are evidencebased guidelines that are commonly used by US poison control centers to determine how much of a specifi c b-blocker or calcium channel blocker may be dangerous. 4,5 These are guidelines only, and each case must be evaluated individually as patients may experience toxic effects at lower or higher doses (Table 1).…”

mentioning

confidence: 99%

“…4 The referral guidelines for calcium channel blockers state that asymptomatic patients who have ingested an SR product are unlikely to show toxic effects 18 to 24 hours after ingestion. 5 …”

mentioning

confidence: 99%

β-Blocker and Calcium Channel Blocker Poisoning: High-Dose Insulin/Glucose Therapy

Bartlett

2016

Critical Care Nurse

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Overdoses of b-blockers and calcium channel blockers can produce significant morbidity and mortality, and conventional therapies often do not work as treatments for these poisonings. High-dose insulin/glucose therapy has been successful in reversing the cardiotoxic effects of these drugs in cases where the standard therapies have failed, and it appears to be relatively safe. Many successes have been well documented, but the clinical experience consists of case reports, the mechanisms of action are not completely understood, and guidelines for use of the therapy are empirically derived and not standardized. Regardless of these limitations, high-dose insulin/glucose therapy can be effective, it is often recommended by clinical toxicologists and poison control centers, and critical care nurses should be familiar with when and how the therapy is used. b-Blocker and Calcium Channel Blocker Poisoning: High-Dose Insulin/ Glucose Therapy H igh-dose insulin/glucose therapy, which is also called hyperinsulinemic/euglycemic therapy or insulin-dextrose therapy, has received considerable attention as a treatment for overdoses of b-blockers and calcium channel blockers that are refractory to conventional therapies. Clinical experience using high-dose insulin/glucose to treat cardiotoxic poisonings in humans dates to 1999, 1 and animal experiments before that time provided the theoretical background and the impetus for extension of its use to treat calcium channel blocker overdoses and then b-blocker overdoses.Despite many articles in medical publications and 15 years of clinical experience with its use, questions remain about how high-dose insulin/glucose therapy works and when and for whom this therapy should be applied. In addition, the dosing guidelines are not standardized. However, high-dose insulin/ glucose therapy is commonly used and often recommended for treating b-blocker and calcium channel blocker poisoning, and critical care nurses should be familiar with the therapy.

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Calcium Channel Blocker Ingestion: An Evidence-Based Consensus Guideline for Out-of-Hospital Management

Cited by 77 publications

References 113 publications

Treatment of poisoning caused by β-adrenergic and calcium-channel blockers

Treatment of poisoning caused by β-adrenergic and calcium-channel blockers

Ischemic Acute Tubular Necrosis due to Diltiazem Overdose

β-Blocker and Calcium Channel Blocker Poisoning: High-Dose Insulin/Glucose Therapy

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