Approach to Calcium Channel Blocker Overdose

Feb 25, 2024

Exploring the challenging case of a 14-year-old patient with depression who ingested a large amount of medications. Discussing the crucial history and physical exam in ingestion work-up. Differentiating between Calcium Channel Blocker and Beta-Blocker overdose based on ECG findings. Detailing the approach to managing Calcium Channel Blocker overdose with resuscitation, IV calcium salts, and vasopressors. Highlighting the importance of early intervention and specific medical therapies in such overdose cases.

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Introduction

00:00 • 5min

Analysis of Calcium Channel Blocker Overdose Case in a 16-Year-Old Patient

04:57 • 2min

Exploring Methylene Blue's Mechanism and Vascular Smooth Muscle Cell Physiology

06:38 • 4min

Understanding the Pathophysiology of Calcium Channel Blocker Overdose

10:23 • 5min

Advanced Therapeutic Management of Calcium Channel Blocker Overdose

15:47 • 10min

Show Introduction

Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists.
Hosted by Dr. Pradip Kamat and Dr. Rahul Damania

Case Presentation

A 14-year-old female with a history of depression and oppositional defiant disorder presents with dizziness, slurring speech, and is pale appearance.
The mother noticed symptoms of dizziness, stumbling, and sleepiness.
The patient had a prior suicide attempt.
Vital signs: HR 50 bpm, BP 75/40, GCS 10.
The initial workup reveals hyperglycemia, and she is stabilized and admitted to the PICU.

Key Aspects of Ingestion Work-up

History and physical exam are crucial.
Stratify acute or chronic ingestions.
Consider baseline medications and coingestants.
Perform initial screening examination to identify immediate measures for stabilization.

Diagnostic Studies

Pulse oximetry, continuous cardiac monitoring, ECG, capillary glucose measurement.
Serum acetaminophen, ASA levels
Consider extended toxicology screen.

Differentiating CCB vs. Beta-Blocker Overdose

ECG findings: PR interval prolongation and Bradydysrhythmia suggest CCB poisoning.
Hyperglycemia in non-diabetic patients may indicate CCB overdose

Approach to CCB Overdose

Initial resuscitation and stabilization
ABC approach
Consult Poison Control Center
Empiric use of glucagon, IV fluids, and vasopressors
Consideration of orogastric lavage and activated charcoal

Specific Medical Therapies

Vasopressors: norepinephrine/epinephrine infusion
Atropine for bradycardia
IV calcium salts to overcome cardiovascular effects
High-dose insulin and dextrose for myocardial function
Investigational therapies: methylene blue, lipid emulsion

Procedures

Transvenous pacemaker placement if needed
ECMO in refractory hypotension

Key Takeaways

Hypotension and bradycardia indicate life-threatening toxidromes.
Differential includes CCB, BB, digoxin, clonidine, and CNS depressants.
Stepwise approach includes close monitoring of ABCs and specific medical therapies.

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References

Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 125 and 126.
St-Onge M et al. Treatment for calcium channel blocker poisoning: a systematic review.
DeRoos F. Calcium channel blockers. In: Goldfrank's Toxicologic Emergencies, 8th edition.