Approach to Calcium Channel Blocker Overdose

Show IntroductionWelcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists.Hosted by Dr. Pradip Kamat and Dr. Rahul DamaniaCase PresentationA 14-year-old female with a history of depression and oppositional defiant disorder presents with dizziness, slurring speech, and is pale appearance.The mother noticed symptoms of dizziness, stumbling, and sleepiness.The patient had a prior suicide attempt.Vital signs: HR 50 bpm, BP 75/40, GCS 10.The initial workup reveals hyperglycemia, and she is stabilized and admitted to the PICU.Key Aspects of Ingestion Work-upHistory and physical exam are crucial.Stratify acute or chronic ingestions.Consider baseline medications and coingestants.Perform initial screening examination to identify immediate measures for stabilization.Diagnostic StudiesPulse oximetry, continuous cardiac monitoring, ECG, capillary glucose measurement.Serum acetaminophen, ASA levelsConsider extended toxicology screen.Differentiating CCB vs. Beta-Blocker OverdoseECG findings: PR interval prolongation and Bradydysrhythmia suggest CCB poisoning.Hyperglycemia in non-diabetic patients may indicate CCB overdoseApproach to CCB OverdoseInitial resuscitation and stabilizationABC approachConsult Poison Control CenterEmpiric use of glucagon, IV fluids, and vasopressorsConsideration of orogastric lavage and activated charcoalSpecific Medical TherapiesVasopressors: norepinephrine/epinephrine infusionAtropine for bradycardiaIV calcium salts to overcome cardiovascular effectsHigh-dose insulin and dextrose for myocardial functionInvestigational therapies: methylene blue, lipid emulsionProceduresTransvenous pacemaker placement if neededECMO in refractory hypotensionKey TakeawaysHypotension and bradycardia indicate life-threatening toxidromes.Differential includes CCB, BB, digoxin, clonidine, and CNS depressants.Stepwise approach includes close monitoring of ABCs and specific medical therapies.Thank you for listening to PICU Doc On Call. We would love for you to share your feedback, subscribe, and review our podcast. Visit picudoconcall.org for more information and resources.Stay tuned for our next episode!ReferencesFuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 125 and 126.St-Onge M et al. Treatment for calcium channel blocker poisoning: a systematic review.DeRoos F. Calcium channel blockers. In: Goldfrank's Toxicologic Emergencies, 8th edition.