Whole Bowel Irrigation and the Hemodynamically Unstable Calcium Channel Blocker Overdose: Primum Non Nocere

Cumpston, Kirk L.; Aks, Steven E.; Sigg, Todd; Pallasch, Erin M.

doi:10.1016/j.jemermed.2007.11.100

Cited by 30 publications

(15 citation statements)

References 10 publications

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“…Five human case series, 23–27 including two pediatric studies, 23 , 24 reported sequelae-free survival of all patients who underwent gastrointestinal decontamination (including activated charcoal, gastric lavage, and whole-bowel irrigation). Cardiac arrests following initiation of whole-bowel irrigation were documented in two case series of hemodynamically unstable patients, 28 , 29 and following gastric lavage in one case report. 30 In all cases, complications occurred after the patient began vomiting.…”

Section: Resultsmentioning

confidence: 99%

Treatment for calcium channel blocker poisoning: A systematic review

St‐Onge

Dubé

Gosselin

et al. 2014

Clinical Toxicology

149

135

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ContextCalcium channel blocker poisoning is a common and sometimes life-threatening ingestion.ObjectiveTo evaluate the reported effects of treatments for calcium channel blocker poisoning. The primary outcomes of interest were mortality and hemodynamic parameters. The secondary outcomes included length of stay in hospital, length of stay in intensive care unit, duration of vasopressor use, functional outcomes, and serum calcium channel blocker concentrations.MethodsMedline/Ovid, PubMed, EMBASE, Cochrane Library, TOXLINE, International pharmaceutical abstracts, Google Scholar, and the gray literature up to December 31, 2013 were searched without time restriction to identify all types of studies that examined effects of various treatments for calcium channel blocker poisoning for the outcomes of interest. The search strategy included the following Keywords: [calcium channel blockers OR calcium channel antagonist OR calcium channel blocking agent OR (amlodipine or bencyclane or bepridil or cinnarizine or felodipine or fendiline or flunarizine or gallopamil or isradipine or lidoflazine or mibefradil or nicardipine or nifedipine or nimodipine or nisoldipine or nitrendipine or prenylamine or verapamil or diltiazem)] AND [overdose OR medication errors OR poisoning OR intoxication OR toxicity OR adverse effect]. Two reviewers independently selected studies and a group of reviewers abstracted all relevant data using a pilot-tested form. A second group analyzed the risk of bias and overall quality using the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist and the Thomas tool for observational studies, the Institute of Health Economics tool for Quality of Case Series, the ARRIVE (Animal Research: Reporting In Vivo Experiments) guidelines, and the modified NRCNA (National Research Council for the National Academies) list for animal studies. Qualitative synthesis was used to summarize the evidence. Of 15,577 citations identified in the initial search, 216 were selected for analysis, including 117 case reports. The kappa on the quality analysis tools was greater than 0.80 for all study types.ResultsThe only observational study in humans examined high-dose insulin and extracorporeal life support. The risk of bias across studies was high for all interventions and moderate to high for extracorporeal life support. High-dose insulin. High-dose insulin (bolus of 1 unit/kg followed by an infusion of 0.5–2.0 units/kg/h) was associated with improved hemodynamic parameters and lower mortality, at the risks of hypoglycemia and hypokalemia (low quality of evidence). Extracorporeal life support. Extracorporeal life support was associated with improved survival in patients with severe shock or cardiac arrest at the cost of limb ischemia, thrombosis, and bleeding (low quality of evidence). Calcium, dopamine, and norepinephrine. These agents improved hemodynamic parameters and survival without documented severe side effects (very low quality of evidence). 4-Aminopyridine. Use of 4-aminopyridine was assoc...

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Section: Resultsmentioning

confidence: 99%

Treatment for calcium channel blocker poisoning: A systematic review

St‐Onge

Dubé

Gosselin

et al. 2014

Clinical Toxicology

149

135

View full text Add to dashboard Cite

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“…Cumpston et al ,5 however, reported two cases of hyperemesis resulting in abdominal distension and aspiration pneumonia and persistent hypotension. While one had haemodynamic instability throughout (and ultimately went into asystole), the other patient became hypotensive 3.5 hours into his bowel irrigation.…”

Section: Discussionmentioning

confidence: 99%

Pharmacological and mechanical management of calcium channel blocker toxicity

Fadhlillah¹,

Patil

2018

BMJ Case Reports

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Cardiovascular instability associated with calcium channel blocker toxicity comprises a small percentage of overdose presentations, yet they are associated with a high mortality rate. We detail the management of a 64-year-old man who took an intentional overdose of 840 mg nimodipine. We include the treatment he received and highlight the scarcity of evidence behind the use of gastric decontamination, calcium, glucagon, intravenous lipid emulsion, high-dose insulin therapy, sodium bicarbonate, vasopressors and methylene blue in calcium channel blocker toxicity. Additionally, the article explores the use of electrical pacing and venoarterial extracorporeal membrane oxygenation (VA-ECMO). Following successful weaning of VA-ECMO, the patient was successfully extubated but remained neurologically impaired due to hypoxic-ischaemic brain injury, critical care polyneuropathy and renal failure requiring dialysis. He has cerebral performance category 3; he has mild cognitive impairment but able to perform some activities of daily living independently and communicate his thoughts and needs. He requires no respiratory or cardiovascular support.

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“…However, especially with sustained release formulations, the use of activated charcoal up to 4 hours after ingestion has been documented to be effective. Lastly, whole-gut lavage with polyethylene glycol solution may be useful in selected cases of ingestion of sustained release tablets, although adverse outcomes have been reported with this treatment modality, especially in patients who are already hemodynamically unstable or who have ileus [4]. …”

Section: Discussionmentioning

confidence: 99%

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

Shah

Goswami

Babu

et al. 2012

Case Reports in Critical Care

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Calcium channel antagonists (CCAs) are commonly involved in drug overdoses. Standard approaches to the management of CCA overdoses, including fluid resuscitation, gut decontamination, administration of calcium, glucagon, and atropine, as well as supportive care, are often ineffective. We report on two patients who improved after addition of hyperinsulinemia-euglycemia (HIE) therapy. We conclude with a literature review on hyperinsulinemia-euglycemia therapy with an exploration of the physiology behind its potential use.

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Whole Bowel Irrigation and the Hemodynamically Unstable Calcium Channel Blocker Overdose: Primum Non Nocere

Cited by 30 publications

References 10 publications

Treatment for calcium channel blocker poisoning: A systematic review

Treatment for calcium channel blocker poisoning: A systematic review

Pharmacological and mechanical management of calcium channel blocker toxicity

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

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