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Management

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  • use of intravenous crystalloid bolus is the mainstay treatment for hypotensive patients (1)
    • monitoring of fluid overload and pulmonary edema is encouraged
    • if hypotension persists, the use of vasopressor agents is warranted
      • use of vasopressors is recommended to restore hemodynamic stability
      • epinephrine and dobutamine are recommended in the presence of cardiogenic shock, while norepinephrine is recommended in vasogenic shock
  • GI decontamination as a modality is rarely done in the emergency department, given the clinical applicability and time for the administration
    • should be considered within the first 1–2 hours post-ingestion of CCBs
    • patients who ingest extended-release formulations may benefit from late GI decontamination (>2 hours)
    • use of this method is not recommended for hemodynamically unstable patients
  • atropine may be administered to patients with symptomatic bradycardia after significant CCB exposure
  • high-dose insulin should be avoided in the absence of a negatively inotropic co-ingestant (2)

Reference:

  1. Alshaya OA et al. Calcium Channel Blocker Toxicity: A Practical Approach. J Multidiscip Healthc. 2022 Aug 30;15:1851-1862.
  2. Isbister GK, Jenkins S, Harris K, Downes MA, Isoardi KZ. Calcium channel blocker overdose: Not all the same toxicity. Br J Clin Pharmacol. 2024; 1-8.

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