Atropine can be used for bradycardia but in general, does not have a significant effect. Management should begin with good supportive care followed by specific therapy. Hyperglycemia is suggestive of calcium channel blocker overdose in the undifferentiated hypotensive and bradycardic patient. In patients who present with hypotension and bradycardia in overdose, beta-blocker toxicity, sedative-hypnotic drug overdose, and hypoglycemia should also be considered. Verapamil is the most deadly of the calcium channel blockers in overdose as it has profound effects on myocardial contractility and peripheral vasodilation. Calcium channel antagonists block slow calcium channels in the myocardium and smooth muscle leading to vasodilation, decreased cardiac contractility, SA node depression and slowing of AV conduction.
The authors and editors of Medscape Reference gratefully acknowledge the medical review of this article by Lada Kokan, MD.The patient is suffering from a calcium channel antagonist (verapamil) overdose manifesting with profound bradycardia and hypotension. John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart & St. John G Benitez, MD, MPH, FACMT, FAACT, FACPM, FAAEM, is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Societyĭavid C Lee, MD Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical Schoolĭavid C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine John G Benitez, MD, MPH, FACMT, FAACT, FACPM, FAAEM, Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center Managing Director, Tennessee Poison Center Systematic review of clinical adverse events reported after acute intravenous lipid emulsion administration. Hayes BD, Gosselin S, Calello DP, Nacca N, Rollins CJ, Abourbih D, et al. Hemodynamic effects of intravenous fat emulsion in an animal model of severe verapamil toxicity resuscitated with atropine, calcium, and saline. Role of intravenous lipid emulsions in the management of calcium channel blocker and β-blocker overdose: 3 years experience of a university hospital. Sebe A, Dişel NR, Açıkalın Akpınar A, Karakoç E. High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning. 37 (6):731-51.Įngebretsen KM, Kaczmarek KM, Morgan J, Holger JS. American Academy of Clinical Toxicology European Association of Poisons Centres and Clinical Toxicologists. Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. Successful treatment of metoprolol-induced cardiac arrest with high-dose insulin, lipid emulsion, and ECMO. Treatment for beta-blocker poisoning: a systematic review. Rotella JA, Greene SL, Koutsogiannis Z, Graudins A, Hung Leang Y, Kuan K, et al. beta-blocker ingestion: an evidence-based consensus guideline for out-of-hospital management. Hemodynamically unstable: accidental atenolol toxicity?. 2019 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 37th Annual Report. Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Brooks DE, Dibert KW, et al. Chiral interactions of the drug propranolol and a1-acid-glycoprotein at a micro liquid-liquid interface.
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