Calcium Channel Blocker OD - Toxicology

Question 1

If a CCB OD patient has hypotension refractory to fluids and/or unstable bradydysrhythmia what medication should you first consider?

Answer 1

Calcium gluconate or calcium chloride
20 mg/kg, max dose of 1g over 20 min

Question 2

In a CCB OD patient requiring calcium, where is calcium chloride preferably infused? Secondary site? Over how long for each site?

Answer 2

Calcium chloride carries the risk of necrosis with extravasation, so the preferred site is a central line over 5 minutes. It can be run in a peripheral IV, preferably in the AC, run over 20 min.

Question 3

In a CCB OD patient what is the first line treatment for unstable bradycardia after calcium? What else is administered to provide cardiac inotropy besides vasopressors?

Answer 3

Unstable bradycardia try atropine 0.5mg q. 3-5 min prn, max .04mg/kg or 3mg (whichever is less). Also patch for Humulin R, 1 u/kg bolus followed by 0.5-2 u/kg infusion. Concurrently administer dextrose 0.5g/kg to a max dose of 25g.

Question 4

For a patient overdosed on CCBs what is used to draw the lipophilic drug out of the blood stream? Hint: it’s used for beta blocker overdoses as well, and the dosing is the same

Answer 4

Intralipid (20%) therapy
1.5 mL/kg over 5 min, may repeat x1, then
infusion of .25 mL/kg to a max total dose of 12 mL/kg