Management

Seek expert advice.

• use of intravenous crystalloid bolus is the mainstay treatment for hypotensive patients (1)
  • monitoring of fluid overload and pulmonary edema is encouraged
  • if hypotension persists, the use of vasopressor agents is warranted
    • use of vasopressors is recommended to restore hemodynamic stability
    • epinephrine and dobutamine are recommended in the presence of cardiogenic shock, while norepinephrine is recommended in vasogenic shock
      
• GI decontamination as a modality is rarely done in the emergency department, given the clinical applicability and time for the administration
  • should be considered within the first 1–2 hours post-ingestion of CCBs
  • patients who ingest extended-release formulations may benefit from late GI decontamination (>2 hours)
  • use of this method is not recommended for hemodynamically unstable patients
    
• atropine may be administered to patients with symptomatic bradycardia after significant CCB exposure
  
• high-dose insulin should be avoided in the absence of a negatively inotropic co-ingestant (2)

Reference:

1. Alshaya OA et al. Calcium Channel Blocker Toxicity: A Practical Approach. J Multidiscip Healthc. 2022 Aug 30;15:1851-1862.
2. Isbister GK, Jenkins S, Harris K, Downes MA, Isoardi KZ. Calcium channel blocker overdose: Not all the same toxicity. Br J Clin Pharmacol. 2024; 1-8.