Management of Calcium Channel Antagonist Overdose with Hyperinsulinemia-Euglycemia Therapy: Case Series and Review of the Literature

Shah, Shreyas; Goswami, Sanjeev Kumar; Babu, Rajesh V.; Sharma, Gulshan; Duarte, Alexander G.

doi:10.1155/2012/927040

Cited by 8 publications

(17 citation statements)

References 24 publications

(20 reference statements)

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“…However, the small number of patients, differing severity of clinical presentation, and the multiple drugs ingested make interpretation of the results difficult. 19 Shah et al 27 reviewed the literature from 1999 to 2010 for case reports and case series, and they located 28 cases. Most cases involved poisoning with calcium channel blockers, but several involved co-ingestants.…”

Section: Clinical Experiencementioning

confidence: 99%

“…28 Shepherd and Klein-Schwartz 23 reviewed the literature from 1996 to 2004. They located 13 cases of calcium channel blocker overdose for which high-dose insulin/ glucose was used: all but 3 had been reviewed by Shah et al 27 Two of these 3 cases were published as abstracts; all 3 patients survived and all 3 received conventional therapy in addition to high-dose insulin/glucose. 23 Many case reports about the use of high-dose insulin/glucose for the treatment of b-blocker and calcium channel blocker poisoning have been published.…”

Section: Clinical Experiencementioning

confidence: 99%

“…30,31 Some authors have stated that high-dose insulin/glucose therapy should be the first treatment used for symptomatic cases of b-blocker or calcium channel blocker overdose 3 and that treatment failures may be caused by delaying its use. 27 Others think that the proper use of insulin-dextrose therapy is as an adjunct. 23,24,32 In a recent article, Levine et al 33 concluded that overdoses of verapamil or diltiazem can be effectively and safely managed with high doses of vasopressors, and they pointed out the relative lack of experience with (and the absence of ) proven dosing and administration guidelines for high-dose insulin/glucose therapy.…”

Section: Clinical Experiencementioning

confidence: 99%

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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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Section: Clinical Experiencementioning

confidence: 99%

Section: Clinical Experiencementioning

confidence: 99%

Section: Clinical Experiencementioning

confidence: 99%

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

Bartlett

2016

Critical Care Nurse

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“…alcium channel blockers (CCB) are widely prescribed for the treatment of cardiovascular diseases and have been demonstrated to be efficacious in the management of hypertension, cardiac arrhythmias and angina. However, toxicity due to overdose is a common and sometimes lifethreatening concern (Shah et al, 2012).The manifestations of toxicity are generally extensions of the drug pharmacologic and therapeutic effects and often include hypotension, bradycardia, conduction block, metabolic acidosis and myocardial depression (DeWitt and Waksman, 2004 ;Kerns, 2007).…”

Section: Introductionmentioning

confidence: 99%

“…Intravenous calcium infusion is logically indicated to overcome intracellular hypocalcemia but the benefit in overdose is unclear and may even be toxic or contraindicated as in patients on digoxin treatment (Liang et al, 2011). Also, inotropics including glucagon and vasopressors therapy often fail to improve hemodynamic status in severely poisoned patients owing C to resistance to respond secondary to underlying pathophysiology and loading complications (Shah et al, 2012;St-Onge et al, 2013). They can increase blood pressure and heart rate, but they also increase systemic vascular resistance which may result in decreases in cardiac output and perfusion of vascular beds.…”

Section: Introductionmentioning

confidence: 99%

The Effect of L-Carnitine and Intralipid Emulsion in Acute Verapamil Cardiotoxicity in Albino Rats

Elawady

Saad

2015

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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Calcium channel blockers (CCB) drugs poisoning continues to be deadly in severe cases despite recent advances and aggressive therapies. Clinically, this toxicity can manifest into severe cardiogenic shock that is often unresponsive to conventional calcium and supportive treatment. This study aimed to investigate the effectiveness of L-carnitine, as an essential compound in cellular energy production, and intralipid emulsion 20% (ILE), as an adjunctive antidote used in selected critically ill poisoned patients, for the treatment of hypotension, Electrocardiogram (ECG) changes and arterial blood gases (ABG) deficits in verapamil poisoned rats, either separately or in combination. The study was conducted on 64 albino rats divided into 8 groups (each of 8 rats). The groups are: group 1 (negative control group), group 2 (Lcarnitine group), group 3 (ILE group), group4 (L-carnitine and ILE group), group 5 (verapamil group), group 6 (verapamil and L-carnitine group), group7 (verapamil and ILE group), group8 (verapamil, Lcarnitine and ILE group). All animals were subjected to measurement of blood pressure, ECG recording, as well as ABG. Results: verapamil toxicity in group 5 was manifested by significant hypotension (both systolic and diastolic), ECG derangements in the form of bradycardia, prolongation of PR and QT intervals and ABG changes in the form of significant low (pH, HCO3, PaO2 and PaCO2). L-carnitine and ILE separate administration with verapamil in group 6 and group 7 respectively improved the blood pressure, heart rate, ECG and ABG parameters but they still showed statistical significant difference with both the control group and group 8, regarding)blood pressure and ECG(in group 6 and)blood pressure, ECG and ABG(in group 7. Co-administration of L-carnitine and ILE together with verapamil in group 8 showed significant improvement of all toxic parameters with insignificant difference with the control group. In conclusion, this study proved that the combined use of L-carnitine and ILE was the most effective treatment of verapamil-induced acute cardiotoxicity. Further studies are recommended on larger scale and on clinical implication to establish more the advantageous and disadvantageous of this novel therapy. It is recommended to use this novel therapy as an additive to the usual regime and when the latter fails to correct potentially fatal cases of CCB poisonings.

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Once was not enough: A case report of the concomitant intoxication of amlodipine (calcium channel blocker) and clonazepam (benzodiazepine)

Gautam¹,

Chamlagain²,

Acharya³

2022

Clinical Case Reports

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Amlodipine besylate is a dihydropyridine (DHP) calcium channel blocker (CCB), which blocks the L-type voltagegated calcium channels in smooth muscle of peripheral vessels. 1,2 Clonazepam is a long-acting and highly potent benzodiazepine (BZD), which acts by increasing the frequency of opening of ligand-gated chloride channel by binding to gamma-amino-butyric acid type A (GABA-A) receptor. 3,4 The clonazepam like other benzodiazepines is used as adjuvant to substance abuse, and commonly coingested with alcohol, ketamine, amphetamine, and gamma-hydroxybutyrate (GHB). 5 To the best of our knowledge, till date, the reported case of clonazepam coingestion with amlodipine is nil.Here, we report a case of concomitant ingestion of amlodipine and clonazepam resulting in hypotension and hypokalemia without noncardiogenic pulmonary edema, which was managed with fluids, insulin, and inotropes. | CASE PRESENTATIONA 25-year-old man was brought to the Emergency Department (ED) after his family members found him unconscious in his bed at 9:00 am in the morning.

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Management of Calcium Channel Antagonist Overdose with Hyperinsulinemia-Euglycemia Therapy: Case Series and Review of the Literature

Cited by 8 publications

References 24 publications

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

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

The Effect of L-Carnitine and Intralipid Emulsion in Acute Verapamil Cardiotoxicity in Albino Rats

Once was not enough: A case report of the concomitant intoxication of amlodipine (calcium channel blocker) and clonazepam (benzodiazepine)

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