Calcium channel blocker toxicity
Calcium Channel Blocker Toxicity
Calcium channel blocker toxicity is a potentially life-threatening condition resulting from an overdose of calcium channel blockers (CCBs), a class of medications commonly used to treat hypertension, angina, and certain cardiac arrhythmias.
Pathophysiology
Calcium channel blockers work by inhibiting the influx of calcium ions through voltage-gated calcium channels in the heart and vascular smooth muscle. This action leads to decreased myocardial contractility, reduced heart rate, and vasodilation. In the case of an overdose, these effects are exaggerated, leading to severe hypotension, bradycardia, and potentially cardiogenic shock.
Clinical Presentation
Patients with calcium channel blocker toxicity may present with a variety of symptoms, including:
In severe cases, patients may develop cardiac arrest or multi-organ failure.
Diagnosis
Diagnosis of calcium channel blocker toxicity is primarily clinical, based on the history of ingestion and presenting symptoms. Laboratory tests may show elevated blood glucose levels and metabolic acidosis. ECG findings may include bradycardia and conduction delays.
Treatment
The management of calcium channel blocker toxicity involves several steps:
Initial Stabilization
- Ensure adequate airway, breathing, and circulation.
- Administer intravenous fluids to support blood pressure.
Specific Therapies
- Calcium: Administer intravenous calcium (calcium chloride or calcium gluconate) to counteract the effects of calcium channel blockade.
- Vasopressors: Use vasopressors such as norepinephrine to maintain blood pressure.
- High-dose insulin therapy: Administer high-dose insulin and glucose to improve cardiac contractility and peripheral perfusion.
- Lipid emulsion therapy: Intravenous lipid emulsion can be used as a "lipid sink" to sequester lipophilic drugs, as shown in the image.
Prognosis
The prognosis of calcium channel blocker toxicity depends on the amount ingested, the time to treatment, and the specific agent involved. Early recognition and aggressive treatment improve outcomes.
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