Management of calcium channel blocker overdoses

Journal of Hospital Medicine

Volumn 9, Issue 10, 2014, Pages 663-668

  Shenoy, Sundeep ^a   Lankala, Shilpa ^b   Adigopula, Sasikanth ^c  

^a UNIVERSITY OF ARIZONA   (United States)

^b BANNER GOOD SAMARITAN MEDICAL CENTER   (United States)

^c UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ATROPINE; BICARBONATE; CALCIUM CHANNEL BLOCKING AGENT; CALCIUM SALT; CATECHOLAMINE; CHARCOAL; GLUCAGON; INSULIN; LEVOSIMENDAN; LIPID EMULSION; CALCIUM DERIVATIVE;

ARTIFICIAL VENTILATION; BRADYCARDIA; COUNTERPULSATION; CRYSTALLOID; DRUG BIOAVAILABILITY; DRUG DETOXIFICATION; DRUG INTOXICATION; DRUG OVERDOSE; ENDOTRACHEAL INTUBATION; EXCITATION CONTRACTION COUPLING; FIRST PASS EFFECT; GLUCONEOGENESIS; GLYCOGENOLYSIS; HEMODIALYSIS; HEMOPERFUSION; HUMAN; HYPERINSULINEMIA EUGLYCEMIA THERAPY; HYPOINSULINEMIA; HYPOTENSION; INSULIN RELEASE; INSULIN RESISTANCE; INSULIN TREATMENT; METABOLIC ACIDOSIS; PATHOPHYSIOLOGY; PRIORITY JOURNAL; REVIEW; SHOCK; HYPERINSULINISM; PROCEDURES; RESPIRATION CONTROL;

AIRWAY MANAGEMENT; CALCIUM CHANNEL BLOCKERS; CALCIUM COMPOUNDS; CATECHOLAMINES; DRUG OVERDOSE; FAT EMULSIONS, INTRAVENOUS; GLUCAGON; HUMANS; HYPERINSULINISM; SODIUM BICARBONATE;

EID: 84908239078     PISSN: 15535592     EISSN: 15535606     Source Type: Journal    
DOI: 10.1002/jhm.2241     Document Type: Review

References (54)

1. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Dart RC. 2010 annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 28th annual report. Clin Toxicol (Phila). 2011;49(10):910-941.
2. Bronstein AC, Spyker DA, Cantilena LR Jr, Rumack BH, Dart RC. 2011 annual report of the American Association Of Poison Control Centers' National Poison Data System (NPDS): 29th annual report. Clin Toxicol (Phila). 2012;50(10):911-1164.
3. Mowry JB, Spyker DA, Cantilena Jr LR, Bailey JE, Ford M. 2012 annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 30th annual report. Clin Toxicol. 2013;51(10):949-1229.
4. Bechtel LK, Haverstick DM, Holstege CP. Verapamil toxicity dysregulates the phosphatidylinositol 3-kinase pathway. Acad Emerg Med. 2008;15(4):368-374.
5. Mokhlesi B, Leikin JB, Murray P, Corbridge TC. Adult toxicology in critical care: part II: specific poisonings. Chest. 2003;123(3):897-922.
6. Kline JA, Tomaszewski CA, Schroeder JD, Raymond RM. Insulin is a superior antidote for cardiovascular toxicity induced by verapamil in the anesthetized canine. J Pharmacol Exp Ther. 1993;267(2):744-750.
7. Arroyo AM, Kao LW. Calcium channel blocker toxicity. Pediatr Emerg Care. 2009;25(8):532-538; quiz 539-540.
8. Rasmussen L, Husted SE, Johnsen SP. Severe intoxication after an intentional overdose of amlodipine. Acta Anaesthesiol Scand. 2003;47(8):1038-1040.
9. Kerns W III. Management of beta-adrenergic blocker and calcium channel antagonist toxicity. Emerg Med Clin North Am. 2007;25(2):309-331; abstract viii.
10. Ohta M, Nelson J, Nelson D, Meglasson MD, Erecinska M. Effect of ca++ channel blockers on energy level and stimulated insulin secretion in isolated rat islets of Langerhans. J Pharmacol Exp Ther. 1993;264(1):35-40.
11. Yuan TH, Kerns WP II, Tomaszewski CA, Ford MD, Kline JA. Insulin-glucose as adjunctive therapy for severe calcium channel antagonist poisoning. J Toxicol Clin Toxicol. 1999;37(4):463-474.
12. Rafael J, Patzelt J. Binding of diltiazem and verapamil to isolated rat heart mitochondria. Basic Res Cardiol. 1987;82(3):246-251.
13. Buss WC, Savage DD, Stepanek J, Little SA, McGuffee LJ. Effect of calcium channel antagonists on calcium uptake and release by isolated rat cardiac mitochondria. Eur J Pharmacol. 1988;152(3):247-253.
14. Kline JA, Raymond RM, Schroeder JD, Watts JA. The diabetogenic effects of acute verapamil poisoning. Toxicol Appl Pharmacol. 1997;145(2):357-362.
15. Levine M, Boyer EW, Pozner CN, et al. Assessment of hyperglycemia after calcium channel blocker overdoses involving diltiazem or verapamil. Crit Care Med. 2007;35(9):2071-2075.
16. Lapatto-Reiniluoto O, Kivisto KT, Neuvonen PJ. Activated charcoal alone and followed by whole-bowel irrigation in preventing the absorption of sustained-release drugs. Clin Pharmacol Ther. 2001;70(3):255-260.
17. Buckley N, Dawson AH, Howarth D, Whyte IM. Slow-release verapamil poisoning. use of polyethylene glycol whole-bowel lavage and high-dose calcium. Med J Aust. 1993;158(3):202-204.
18. Cumpston KL, Aks SE, Sigg T, Pallasch E. Whole bowel irrigation and the hemodynamically unstable calcium channel blocker overdose: primum non nocere. J Emerg Med. 2010;38(2):171-174.
19. Levine M, Curry SC, Padilla-Jones A, Ruha A. Critical care management of verapamil and diltiazem overdose with a focus on vasopressors: a 25-year experience at a single center. Ann Emerg Med. 2013;62(3):252-258.
20. Kline JA, Leonova E, Raymond RM. Beneficial myocardial metabolic effects of insulin during verapamil toxicity in the anesthetized canine. Crit Care Med. 1995;23(7):1251-1263.
21. Hariman RJ, Mangiardi LM, McAllister RG Jr, Surawicz B, Shabetai R, Kishida H. Reversal of the cardiovascular effects of verapamil by calcium and sodium: differences between electrophysiologic and hemodynamic responses. Circulation. 1979;59(4):797-804.
22. Zhou H, Liu Y, Li GQ, Wei LQ. A novel dosing regimen for calcium infusion in a patient of massive overdose of sustained-release nifedipine. Am J Med Sci. 2013;345(3):248-251.
23. Luscher TF, Noll G, Sturmer T, Huser B, Wenk M. Calcium gluconate in severe verapamil intoxication. N Engl J Med. 1994;330(10):718-720.
24. Lam YM, Tse HF, Lau CP. Continuous calcium chloride infusion for massive nifedipine overdose. Chest. 2001;119(4):1280-1282.
25. Sim MT, Stevenson FT. A fatal case of iatrogenic hypercalcemia after calcium channel blocker overdose. J Med Toxicol. 2008;4(1):25-29.
26. Hung YM, Olson KR. Acute amlodipine overdose treated by high dose intravenous calcium in a patient with severe renal insufficiency. Clin Toxicol (Phila). 2007;45(3):301-303.
27. Bailey B. Glucagon in beta-blocker and calcium channel blocker overdoses: a systematic review. J Toxicol Clin Toxicol. 2003;41(5):595-602.
28. Papadopoulos J, O'Neil MG. Utilization of a glucagon infusion in the management of a massive nifedipine overdose. J Emerg Med. 2000;18(4):453-455.
29. Love JN, Sachdeva DK, Bessman ES, Curtis LA, Howell JM. A potential role for glucagon in the treatment of drug-induced symptomatic bradycardia. Chest. 1998;114(1):323-326.
30. Erickson FC, Ling LJ, Grande GA, Anderson DL. Diltiazem overdose: case report and review. J Emerg Med. 1991;9(5):357-366.
31. Reikeras O, Gunnes P, Sorlie D, Ekroth R, Jorde R, Mjos OD. Haemodynamic effects of high doses of insulin during acute left ventricular failure in dogs. Eur Heart J. 1985;6(5):451-457.
32. Farah AE, Alousi AA. The actions of insulin on cardiac contractility. Life Sci. 1981;29(10):975-1000.
33. Greene SL, Gawarammana I, Wood DM, Jones AL, Dargan PI. Relative safety of hyperinsulinaemia/euglycaemia therapy in the management of calcium channel blocker overdose: a prospective observational study. Intensive Care Med. 2007;33(11):2019-2024.
34. Espinoza TR, Bryant SM, Aks SE. Hyperinsulin therapy for calcium channel antagonist poisoning: a seven-year retrospective study. Am J Ther. 2013;20(1):29-31.
35. Lheureux PE, Zahir S, Gris M, Derrey AS, Penaloza A. Bench-to-bedside review: hyperinsulinaemia/euglycaemia therapy in the management of overdose of calcium-channel blockers. Crit Care. 2006;10(3):212.
36. Engebretsen KM, Kaczmarek KM, Morgan J, Holger JS. High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning. Clin Toxicol (Phila). 2011;49(4):277-283.
37. Gradinac S, Coleman GM, Taegtmeyer H, Sweeney MS, Frazier OH. Improved cardiac function with glucose-insulin-potassium after aortocoronary bypass grafting. Ann Thorac Surg. 1989;48(4):484-489.
38. von Lewinski D, Gasser R, Rainer PP, et al. Functional effects of glucose transporters in human ventricular myocardium. Eur J Heart Fail. 2010;12(2):106-113.
39. Hsu CH, Wei J, Chen YC, Yang SP, Tsai CS, Lin CI. Cellular mechanisms responsible for the inotropic action of insulin on failing human myocardium. J Heart Lung Transplant. 2006;25(9):1126-1134.
40. Agarwal A, Yu SW, Rehman A, Henkle JQ. Hyperinsulinemia euglycemia therapy for calcium channel blocker overdose: a case report. Tex Heart Inst J. 2012;39(4):575-578.
41. Ionescu-Tirgoviste C, Bruckner I, Mihalache N, Ionescu C. Plasma phosphorus and magnesium values during treatment of severe diabetic ketoacidosis. Med Interne. 1981;19(1):63-68.
42. Kebler R, McDonald FD, Cadnapaphornchai P. Dynamic changes in serum phosphorus levels in diabetic ketoacidosis. Am J Med. 1985;79(5):571-576.
43. Montiel V, Gougnard T, Hantson P. Diltiazem poisoning treated with hyperinsulinemic euglycemia therapy and intravenous lipid emulsion. Eur J Emerg Med. 2011;18(2):121-123.
44. Bania TC, Chu J, Perez E, Su M, Hahn I. Hemodynamic effects of intravenous fat emulsion in an animal model of severe verapamil toxicity resuscitated with atropine, calcium, and saline. Acad Emerg Med. 2007;14(2):105-111.
45. Jamaty C, Bailey B, Larocque A, Notebaert E, Sanogo K, Chauny JM. Lipid emulsions in the treatment of acute poisoning: a systematic review of human and animal studies. Clin Toxicol (Phila). 2010;48(1):1-27.
46. Weinberg G, Ripper R, Feinstein DL, Hoffman W. Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity. Reg Anesth Pain Med. 2003;28(3):198-202.
47. Corman SL, Skledar SJ. Use of lipid emulsion to reverse local anesthetic-induced toxicity. Ann Pharmacother. 2007;41(11):1873-1877.
48. Weinberg GL. Lipid resuscitation: more than a sink. Crit Care Med. 2012;40(8):2521-2523.
49. Fettiplace MR, Ripper R, Lis K, et al. Rapid cardiotonic effects of lipid emulsion infusion. Crit Care Med. 2013;41(8):e156-e162.
50. Tebbutt S, Harvey M, Nicholson T, Cave G. Intralipid prolongs survival in a rat model of verapamil toxicity. Acad Emerg Med. 2006;13(2):134-139.
51. Brull SJ. Lipid emulsion for the treatment of local anesthetic toxicity: patient safety implications. Anesth Analg. 2008;106(5):1337-1339.
52. Kolecki PF, Curry SC. Poisoning by sodium channel blocking agents. Crit Care Clin. 1997;13(4):829-848.
53. Osthoff M, Bernsmeier C, Marsch SC, Hunziker PR. Levosimendan as treatment option in severe verapamil intoxication: a case report and review of the literature. Case Rep Med. 2010;2010. pii: 546904.
54. Wolf LR, Spadafora MP, Otten EJ. Use of amrinone and glucagon in a case of calcium channel blocker overdose. Ann Emerg Med. 1993;22(7):1225-1228.