Clinical Pediatric Emergency Medicine
Volume 6, Issue 2 , Pages 109-115 , June 2005

Calcium-Channel Blocker Overdose

  • Angela C. Anderson, MD, FAAP

      Affiliations

    • Corresponding Author InformationReprint requests and correspondence: Angela C. Anderson, MD, FAAP, Department of Emergency Medicine, Clinical Toxicology, Hasbro Children's Hospital, Brown University Medical School, Providence, RI 02903, USA.

References 

  1. In:  Hardman J,  Limbird L editor. Goodman & Gilman's the pharmacological basis of therapeutics. 10th ed.. New York (NY): McGraw-Hill; 2001;p. 843–847
  2. Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 2004;22:335–404
  3. In:  Goldfrank LR,  Flomenbaum NE,  Lewin NA editor. Toxicologic emergencies. 7th ed.. New York (NY): McGraw-Hill; 2002;p. 762–771
  4. In:  Dart RC editors. Medical toxicology. Philadelphia (PA): Lippincott Williams & Wilkins; 2004;p. 695–699
  5. In:  Haddad LM,  Shannon MW,  Winchester JF editor. Clinical management of poisoning and drug overdose. 3rd ed.. Philadelphia (PA): WB Saunders Company; 1998;p. 1020–1030
  6. Ram CV, Fenves A. Clinical pharmacology of antihypertensive drugs. Cardiol Clin. 2002;20:265–280
  7. Yuan TH, Kerns WP, Tomaszewski CA. Insulin-glucose as adjunctive therapy for severe calcium channel antagonist poisoning. J Toxicol Clin Toxicol. 1999;37:463–474
  8. Ramoska EA, Spiller HA, Myers A. Calcium channel blocker toxicity. Ann Emerg Med. 1990;19:649–653
  9. Isradipine, in MD Consult. 2004. Available at: (http://home.mdconsult.com.revproxy.brown.edu/das/drug/view/47721146-2/1/3014/top?sid=372887558).
  10. Belson MG, Gorman SE, Sullivan K, Geller RJ. Calcium channel blocker ingestions in children. Am J Emerg Med. 2000;18:581–586
  11. Edvardsson N, Varnauskas E. Clinical course, serum concentrations and elimination rate in a case of massive sotalol intoxication. Eur Heart J. 1987;8:544–548
  12. Henderson A, Stevenson N, Hackett LP. Diltiazem overdose in an elderly patient: efficacy of adrenaline. Anaesth Intensive Care. 1992;20:507–510
  13. Horowitz BZ, Rhee KJ. Massive verapamil ingestion: a report of two cases and a review of the literature. Am J Emerg Med. 1989;7:624–631
  14. Humbert VH, Munn NJ, Hawkins RF. Noncardiogenic pulmonary edema complicating massive diltiazem overdose. Chest. 1991;99:258–259
  15. Sami Karti S, Ulusoy H, Yandi M, Gunduz A. Non-cardiogenic pulmonary oedema in the course of verapamil intoxication. Emerg Med J. 2002;19:458–459
  16. 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;158:202–204
  17. Durward A, Guerguerian AM, Lefebvre M, Shemie SD. Massive diltiazem overdose treated with extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2003;4:372–376
  18. Salhanick SD, Shannon MW. Management of calcium channel antagonist overdose. Drug Saf. 2003;26:65–79
  19. Anthony T, Jastremski M, Elliott W, et al. Charcoal hemoperfusion for the treatment of a combined diltiazem and metoprolol overdose. Ann Emerg Med. 1986;15:1344–1348
  20. Albertson TE, Dawsson A, de Latorre F, et al. TOX-ACLS: toxicologic-oriented advanced cardiac life support. Ann Emerg Med. 2001;37(4 Suppl):S78–S90
  21. Howarth DM, Dawson AH, Smith AJ, et al. Calcium channel blocking drug overdose: an Australian series. Hum Exp Toxicol. 1994;13:161–166
  22. Haddad LM. Resuscitation after nifedipine overdose exclusively with intravenous calcium chloride. Am J Emerg Med. 1996;14:602–603
  23. Crump BJ, Holt DW, Vale JA. Lack of response to intravenous calcium in severe verapamil poisoning. Lancet. 1982;2:939–940
  24. Strubelt O. Antidotal treatment of the acute cardiovascular toxicity of verapamil. Acta Pharm Toxicol. 1984;55:231–237
  25. Buckley NA, Whyte IM, Dawson AH. Overdose with calcium channel blockers. BMJ. 1994;308:1639
  26. Lam YM, Tse HF, Lau CP. Continuous calcium chloride infusion for massive nifedipine overdose. Chest. 2001;119:1280–1282
  27. Marques M, Gomes E, de Oliveira J. Treatment of calcium channel blocker intoxication with insulin infusion: case report and literature review. Resuscitation. 2003;57:211–213
  28. Boyer EW, Shannon M. Treatment of calcium-channel–blocker intoxication with insulin infusion. N Engl J Med. 2001;344:1721–1722
  29. Kline JA, Leonova E, Raymond RM. Beneficial myocardial metabolic effects of insulin during verapamil toxicity in the anesthetized canine. Crit Care Med. 1995;23:1251–1263
  30. 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;267:744–750
  31. Bailey B. Glucagon in beta-blocker and calcium channel blocker overdoses: a systematic review. J Toxicol Clin Toxicol. 2003;41:595–602
  32. Tuncok Y, Apaydin S, Gidener S, et al. The effects of amrinone and glucagon on verapamil-induced myocardial depression in a rat isolated heart model. Gen Pharmacol. 1997;28:773–776
  33. Howard DC. Glucagon for reaction to combined calcium channel blocker and beta-blocker use. J Emerg Nurs. 1996;22:173–175
  34. Walter FG, Frye G, Mullen JT, et al. Amelioration of nifedipine poisoning associated with glucagon therapy. Ann Emerg Med. 1993;22:1234–1237
  35. Doyon S, Roberts JR. The use of glucagon in a case of calcium channel blocker overdose. Ann Emerg Med. 1993;22:1229–1233
  36. Wolf LR, Spadafora MP, Otten EJ. Use of amrinone and glucagon in a case of calcium channel blocker overdose. Ann Emerg Med. 1993;22:1225–1228
  37. Zaritsky AL, Horowitz M, Chernow B. Glucagon antagonism of calcium channel blocker-induced myocardial dysfunction. Crit Care Med. 1988;16:246–251
  38. White CM. A review of potential cardiovascular uses of intravenous glucagon administration. J Clin Pharmacol. 1999;39:442–447
  39. In:  Ford M,  Delaney K,  Ling L,  Erikson T editor. Clinical toxicology. Philadelphia (PA): WB Saunders Company; 2001;
  40. Burda AM, Kapustka CA. Reformulated glucagon diluent phenol-free. J Toxicol Clin Toxicol. 1999;37:127
  41. Roberge RJ, Rossetti ML, Rosetti JM. Aminophylline reversal of antihypertensive agent toxicity. Vet Hum Toxicol. 2001;43:285–287
  42. Holzer M, Sterz F, Schoerkhuber W. Successful resuscitation of a verapamil-intoxicated patient with percutaneous cardiopulmonary bypass. Crit Care Med. 1999;27:2818–2823
  43. Whitehurst VE, Vick JA, Alleva FR, et al. Reversal of propranolol blockade of adrenergic receptors and related toxicity with drugs that increase cyclic AMP. Proc Soc Exp Biol Med. 1999;221:382–385
  44. Sys SU, Boels PJ, Brutsaert DL. Positive inotropic and vasodilating effects of amrinone and milrinone in isolated canine heart. J Cardiovasc Pharmacol. 1987;10:445–449
  45. Sztajnkrycer MD, Bond GR, Johnson SB, Weaver AL. Use of vasopressin in a canine model of severe verapamil poisoning: a preliminary descriptive study. Acad Emerg Med. 2004;11:1253–1261
  46. Lee DC, Greene T, Dougherty T, Pearigen P. Fatal nifedipine ingestions in children. J Emerg Med. 2000;19:359–361
  47. Frierson J, Bailly D, Shultz T, et al. Refractory cardiogenic shock and complete heart block after unsuspected verapamil-SR and atenolol overdose. Clin Cardiol. 1991;14:933–935
  48. Brayer AF, Wax P. Accidental ingestion of sustained release calcium channel blockers in children. Vet Hum Toxicol. 1998;40:104–106
  49. Osterhoudt KC, Henretig FM. How much confidence that calcium channel blockers are safe?. Vet Hum Toxicol. 1998;40:239

PII: S1522-8401(05)00059-5

doi: 10.1016/j.cpem.2005.04.007

Clinical Pediatric Emergency Medicine
Volume 6, Issue 2 , Pages 109-115 , June 2005