Calcium channel blocker overdose
| Calcium channel blocker toxicity | |
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| Synonyms | Calcium channel blocker poisoning, calcium channel blocker overdose |
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| A 20% lipid emulsion commonly used for calcium channel blocker toxicity | |
| Specialty | Emergency medicine |
| Symptoms | Slow heart rate, low blood pressure, nausea, vomiting, sleepiness |
| Complications | Cardiac arrest |
| Usual onset | Within 6 hours |
| Causes | Too much calcium channel blockers either by accident or on purpose |
| Similar conditions | Beta blocker toxicity |
| Treatment | Activated charcoal, whole bowel irrigation, intravenous fluids, calcium gluconate, glucagon, high dose insulin, vasopressors, lipid emulsion |
| Prognosis | High risk of death |
| Frequency | > 10,000 (US) |
| Classification |
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| External resources |
Calcium channel blocker toxicity is the taking of too much of the medications known as calcium channel blockers (CCBs) either by accident or on purpose. This often causes a slow heart rate and low blood pressure. This can progress to the heart stopping altogether. Some CCBs can also cause a fast heart rate as a result of the low blood pressure. Other symptoms may include nausea, vomiting, sleepiness, and shortness of breath. Symptoms usually occur in the first six hours but with some forms of the medication may not start until 24 after hours.
There are a number of treatments that may be useful. These include efforts to reduce absorption of the drug including: activated charcoal taken by mouth if given shortly after the ingestion or whole bowel irrigation if an extended release formula was taken. Efforts to cause vomiting are not recommended. Medications to treat the toxic effects include: intravenous fluids, calcium gluconate, glucagon, high dose insulin, vasopressors and lipid emulsion.Extracorporeal membrane oxygenation may also be an option.
More than ten thousand cases of calcium channel blocker toxicity were reported in the United States in 2010. Along with beta blockers and digoxin calcium channel blockers have one of the highest rates of death in overdose. These medications first became available in the 1970s and 1980s. They are one of the few types of medication in which one pill can result in the death of a child.
Most people who have taken too much of a calcium channel blocker, especially diltiazem, get slow heart rate and low blood pressure. This can progress to the heart stopping altogether. CCBs of the dihydropyridine group, as well as flunarizine, predominantly cause reflex tachycardia as a reaction to the low blood pressure. For verapamil, despite it having a similar mechanism of action as diltiazem, both fast and slow heart rhythm are described.
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