Wednesday October 25, 2006
Re: Calcium Channel blocker overdose


Editors' note: In response to our pearl on Saturday October 21, 2006 regarding Calcium Channel Blocker overdose, we received following feedback which is worth sharing.


"...First, I want to congratulate you on a most excellent website. I always enjoy reading the daily pearls. The daily pearl for 10/21/06 is regarding CCB overdose and potential treatments with glucagon and amrinone. One very important treatment strategy for Beta-blocker (BB) or Calcium-Channel-Blocker (CCB) overdoses resistant to the above traditional antidotes is the use of hyperinsulin/euglycemia therapy. (I have personally used this on a propranolol overdose with much success). This is the treatment of the future and widely reccommended by the toxicology folks and should always be noted as a potential salvage therapy when the traditional approaches fail. I have attached 2 recommended readings 1, 2 regarding HDIDK (High Dose Insulin Dextrose Potassium) in regards to treatment of CCB and BB toxicity.

Thanks,
C Brackney, DO
St Bernards Hospital,Midwestern University / Chicago College of Osteopathic Medicine
Emergency Medicine Residency ProgramChicago, IL


As both attached references are from subscription journals, we put link to abstracts below but there is a free review available: Treatment of poisoning caused by ß-adrenergic and calcium-channel blockers , GREENE SHEPHERD, PHARM.D., DABAT, Clinical Associate Professor, Medical College of Georgia, Augusta, GA (reference: American Journal of Health-System Pharmacy, Vol. 63, Issue 19, 1828-1835)



Recommended Reading:

Treatment of Calcium-Channel–Blocker Intoxication with Insulin Infusion - The New England Journal of Medicine , May 31, 2001, Volume 344:1721-1722
High-Dose Insulin Therapy for Calcium-Channel Blocker Overdose - Shepherd and Klein-Schwartz Ann Pharmacother.2005; 39: 923-930