Extracorporeal treatment for calcium channel blocker poisoning: systematic review and recommendations from the EXTRIP workgroup

Wong, Anselm; Hoffman, Robert S.; Walsh, Steven J.; Roberts, Darren M.; Gosselin, Sophie; Bunchman, Timothy E.; Kebede, Sofia; Lavergne, Valéry; Ghannoum, Marc; workgroup, Extrip

doi:10.1080/15563650.2020.1870123

Cited by 22 publications

(22 citation statements)

References 190 publications

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“…Finally, the preparation of albumin dialysate is labor-intensive and costly. 23 , 24 The optimal concentration of albumin necessary to achieve benefit while limiting unnecessary excess albumin is currently unknown. Churchwell et al showed a relationship between the albumin concentration and the clearance of valproic acid and carbamazepine, but not phenytoin.…”

Section: Discussionmentioning

confidence: 99%

Single-Pass Albumin Dialysis as Rescue Therapy for Pediatric Calcium Channel Blocker Overdose

Essink

Berg

Montange

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

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Calcium channel blocker ingestions remain one of the leading causes of death related to cardiovascular medication ingestion in both adults and pediatric patients. We report a case of a 17-year-old, 103 kg female presenting after an intentional polypharmacy ingestion, including 500 to 550 mg of amlodipine. She presented with profound vasoplegia and cardiovascular collapse requiring high-dose inotropes and eventual life support with extracorporeal membrane oxygenation (ECMO). Current available treatments, designed for adults, including lipid emulsion and methylene blue, provided no sustained clinical improvement. This resulted in the initiation of single-pass albumin dialysis (SPAD). We aim to describe the clinical implications, amlodipine toxic dose effects, and clinical challenges associated with large pediatric patients and high-dose medications. We also discuss several challenges encountered related to dosing and concentration of medications, which led to fluid overload. Given the ongoing obesity epidemic, we routinely see pediatric patients of adult size. This will continue to challenge pediatric use of adult dosing and concentrations to avoid excessive fluid administration for high-dose medications, such as insulin and vasoactive agents. To our knowledge, this is the first successful case of using SPAD in conjunction with ECMO for salvage therapy after refractory life-threatening calcium channel blocker toxicity.

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Section: Discussionmentioning

confidence: 99%

Single-Pass Albumin Dialysis as Rescue Therapy for Pediatric Calcium Channel Blocker Overdose

Essink

Berg

Montange

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

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“…Haemodialysis and haemofiltration are ineffective modes of therapy due to the large volume of CCBs distribution (5.5 l/ kg for verapamil) and their predilection to bind to plasma proteins [3]. Although the use of extracorporeal treatments has been suggested, the work group recommend against this method in CCBs poisoning [34]. Lipid emulsion therapy (LET) involves the intravenous injection of lipid emulsion, which creates lipid phase within the blood and binds to lipidsoluble drugs, thus reducing their volume of distribution.…”

Section: Discussionmentioning

confidence: 99%

Importance of early intervention in verapamil overdose – Case Report and antidotes review

Marzęda¹,

Drozd²,

Tchórz³

et al. 2021

J Pre Clin Clin Res.

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Introduction.Verapamil is a widely used cardiac drug. It belongs to the non-dihydropiridine subgroup of calcium channel blockers (CCBs), and is used mainly for the treatment of atrial dysrhythmias, hypertension or angina. In this article, we describe a case of poisoning with verapamil mixed with ethanol and review current treatment options. A 54-year-old female was admitted to the Toxicology Clinic by emergency medical services after ingesting sustained-release CCBs and ethanol in a suicidal attempt. The patient was successfully treated by administration of catecholamines and calcium, and the introduction of a high-dose insulin infusion (HDI). Conclusions. This case report emphasizes that even in severe poisoning, early and proper intervention may prevent circulatory breakdown. It also summarizes treatment options in patients after verapamil overdose. Along with decontamination, administration of catecholamines and correcting electrolyte abnormalities, the main options are HDI and lipid emulsion therapy (LET).

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“…Eğer kalsiyum kanalları tamamen kalsiyum kanal blokerleriyle (verapamil, diltiazem) doyurulmuşsa L tipi kanallarda %100'e yakın kapalı olacaktır ve yüksek plazma kalsiyum seviyesi kardiyak fonksiyonları arttırmayacaktır. Kalsiyum infüzyonu kusmaya, akut ritm bozuklukları (özellikle hızlı verildiğinde, asistole kadar varan) ve lokal irritasyona neden olabileceğinden infüzyon esnasında komplikasyonlar açısından dikkatli olunmalıdır (3,4,(6)(7)(8)10,13,17). Glukagon: Kalsiyum infüzyonuna klinik cevap yetersiz ise hastanın hipotansiyonu devam ediyorsa tedaviye glukagon eklenmelidir.…”

Section: Antidotlar Kalsiyumunclassified

Kalsiyum Kanal Blokeri Zehirlenmeleri

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TAŞKIN

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2022

Anatolian Journal of Emergency Medicine

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Calcium channel blockers are a group of cardiovascular drugs that used very common in society. Since doctors frequently prescribed them and are easily accessible, it is very common to encounter in the emergency departments with overdose to aim suicide. The overdose of these drugs causes mortality by resistant shock, mortal bradyarrhythmia, cardiogenic shock and multiple organ failure. It is vital to diagnose and treat early. Even though these drugs cause mortality by resistant shock, it can be successfully treatable with effective antidotes and current treatment methods. In this review, we aim to discuss CCBs poisonings widely with current literature.

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Extracorporeal treatment for calcium channel blocker poisoning: systematic review and recommendations from the EXTRIP workgroup

Cited by 22 publications

References 190 publications

Single-Pass Albumin Dialysis as Rescue Therapy for Pediatric Calcium Channel Blocker Overdose

Single-Pass Albumin Dialysis as Rescue Therapy for Pediatric Calcium Channel Blocker Overdose

Importance of early intervention in verapamil overdose – Case Report and antidotes review

Kalsiyum Kanal Blokeri Zehirlenmeleri

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