Saturday October 21, 2006
Calcium Channel blocker overdose


Q; Which 'Calcium Channel Blocker' overdose may not produce noticeable hypotension but severe heart blocks (and may decieve the diagnosis) ?

A; Diltiazem. Most of the CCB overdose produce significant hypotension as expected but Dilitiazem may decieve you by just producing heart blocks.


2 important pearls in treating CCB overdose beside calcium infusion and standard hemodynamic support.

1. 5 - 15 mg IV Glucagon is a viable adjuvant treatment in calcium channel bloker overdose. But it is advisible to administer Glucagon before calcium infusion is given, as erratic blood calcium level may mask full effect of glucagon. Glucagon via cAMP increases cardiac contractility and counter heart blocks.

2. Consider adding Inocor (amrinone) infusion. It is a Phosphodiesterase inhibitor and has 2 actions. 1) it delays release of calcium into the cell 2) it increases cardiac contractility via cAMP.