Calcium channel blockers severe poisoning
Keywords:
CALCIUM CHANNEL BLOCKERS
Abstract
Calcium channel blockers poisoning can result in a severe condition. The study presents the case of a patient suffering from severe poisoning caused by diltiazem who developed a deep shock and multiple organ dysfunction. Hemodynamics instability may be refractory to the usual therapeutic measures, requiring the implementation of adjuvant therapy to support vital functions. The study examines the clinical presentation and pathophysiology of calcium channel blockers. Last, the therapeutic alternatives are presented based on current evidence.
References
(1) DeWitt CR, Waksman JC. Pharmacology, pathophysiology and management of calcium channel blocker and beta-blocker toxicity. Toxicol Rev 2004; 23(4):223-38.
(2) Salhanick SD, Shannon MW. Management of calcium channel antagonist overdose. Drug Saf 2003; 26(2):65-79.
(3) Shah SK, Goswami SK, Babu RV, Sharma G, Duarte AG. Management of calcium channel antagonist overdose with hyperinsulinemia-euglycemia therapy: case series and review of the literature. Case Rep Crit Care 2012; 2012: 927040 doi: 10.1155/2012/927040. Disponible en: http://www.hindawi.com/crim/cc/2012/927040/cta/. Consulta: 5 mayo 2012.
(4) Lheureux PE, Zahir S, Gris M, Derrey AS, Penaloza A. Bench-to-bedside review: hyperinsulinaemia/euglycaemia therapy in the management of overdose of calcium-channel blockers. Crit Care 2006; 10(3):212-7.
(5) Newton CR, Delgado JH, Gomez HF. Calcium and beta receptor antagonist overdose: a review and update of pharmacological principles and management. Semin Respir Crit Care Med 2002; 23(1):19-25.
(6) Satchithananda DK, Stone DL, Chauhan A, Ritchie AJ. Lesson of the week: unrecognised accidental overdose with diltiazem. BMJ 2000; 321(7254):160-1.
(7) Min L, Deshpande K. Diltiazem overdose haemodynamic response to hyperinsulinaemia-euglycaemia therapy: a case report. Crit Care Resus 2004; 6(1):28-30.
(8) Comellas AP, Kelly AM, Trejo HE, Briva A, Lee J, Sznajder JI, et al. Insulin regulates alveolar epithelial function by inducing Na+/K+-ATPase translocation to the plasma membrane in a process mediated by the action of Akt. J Cell Sci 2010; 123(Pt 8):1343-51.
(9) Humbert VH Jr, Munn NJ, Hawkins RF. Noncardiogenic pulmonary edema complicating massive diltiazem overdose. Chest 1991; 99(1):258-9.
(10) Roper TA, Sykes R, Gray C. Fatal diltiazem overdose: report of four cases and review of the literature. Postgrad Med J 1993; 69(812):474-6.
(11) de Pont AC. Extracorporeal treatment of intoxications. Curr Opin Crit Care 2007; 13(6):668-73.
(12) Morales MG, Guerrero SG, García GR, Villalobos SJ, Camarena AG, Aguirre SJ, et al. Intoxicación grave con verapamilo. Arch Cardiol Mex. 2005; 75 (Suppl 3):S3-5.
(13) Harris NS. Case records of the Massachusetts General Hospital: case 24-2006. A 40-year-old woman with hypotension after an overdose of amlodipine. N Engl J Med 2006; 355(6):602-11.
(14) Engebretsen KM, Kaczmarek KM, Morgan J, Holger JS. High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning. Clin Toxicol (Phila) 2011; 49(4):277-83.
(15) Kline JA, Raymond RM, Leonova ED, Williams TC, Watts JA. Insulin improves heart function and metabolism during non-ischemic cardiogenic shock in awake canines. Cardiovasc Res 1997; 34(2):289-98.
(16) Boyer EW, Shannon M. Treatment of calcium-channel-blocker intoxication with insulin infusion. N Engl J Med 2001; 344(22):1721-2.
(17) Greene SL, Gawarammana I, Wood DM, Jones AL, Dargan PI. Relative safety of hyperinsulinaemia/euglycaemia therapy in the management of calcium channel blocker overdose: a prospective observational study. Intensive Care Med 2007; 33(11):2019-24.
(18) Varpula T, Rapola J, Sallisalmi M, Kurola J. Treatment of serious calcium channel blocker overdose with levosimendan, a calcium sensitizer. Anesth Analg 2009; 108(3):790-2.
(19) Osthoff M, Bernsmeier C, Marsch SC, Hunziker PR. Levosimendan as treatment option in severe verapamil intoxication: a case report and review of the literature. Case Report Med 2010; 2010. pii: 546904. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931406/pdf/CRM2010-546904.pdf. Consulta: 10 marzo 2012.
(2) Salhanick SD, Shannon MW. Management of calcium channel antagonist overdose. Drug Saf 2003; 26(2):65-79.
(3) Shah SK, Goswami SK, Babu RV, Sharma G, Duarte AG. Management of calcium channel antagonist overdose with hyperinsulinemia-euglycemia therapy: case series and review of the literature. Case Rep Crit Care 2012; 2012: 927040 doi: 10.1155/2012/927040. Disponible en: http://www.hindawi.com/crim/cc/2012/927040/cta/. Consulta: 5 mayo 2012.
(4) Lheureux PE, Zahir S, Gris M, Derrey AS, Penaloza A. Bench-to-bedside review: hyperinsulinaemia/euglycaemia therapy in the management of overdose of calcium-channel blockers. Crit Care 2006; 10(3):212-7.
(5) Newton CR, Delgado JH, Gomez HF. Calcium and beta receptor antagonist overdose: a review and update of pharmacological principles and management. Semin Respir Crit Care Med 2002; 23(1):19-25.
(6) Satchithananda DK, Stone DL, Chauhan A, Ritchie AJ. Lesson of the week: unrecognised accidental overdose with diltiazem. BMJ 2000; 321(7254):160-1.
(7) Min L, Deshpande K. Diltiazem overdose haemodynamic response to hyperinsulinaemia-euglycaemia therapy: a case report. Crit Care Resus 2004; 6(1):28-30.
(8) Comellas AP, Kelly AM, Trejo HE, Briva A, Lee J, Sznajder JI, et al. Insulin regulates alveolar epithelial function by inducing Na+/K+-ATPase translocation to the plasma membrane in a process mediated by the action of Akt. J Cell Sci 2010; 123(Pt 8):1343-51.
(9) Humbert VH Jr, Munn NJ, Hawkins RF. Noncardiogenic pulmonary edema complicating massive diltiazem overdose. Chest 1991; 99(1):258-9.
(10) Roper TA, Sykes R, Gray C. Fatal diltiazem overdose: report of four cases and review of the literature. Postgrad Med J 1993; 69(812):474-6.
(11) de Pont AC. Extracorporeal treatment of intoxications. Curr Opin Crit Care 2007; 13(6):668-73.
(12) Morales MG, Guerrero SG, García GR, Villalobos SJ, Camarena AG, Aguirre SJ, et al. Intoxicación grave con verapamilo. Arch Cardiol Mex. 2005; 75 (Suppl 3):S3-5.
(13) Harris NS. Case records of the Massachusetts General Hospital: case 24-2006. A 40-year-old woman with hypotension after an overdose of amlodipine. N Engl J Med 2006; 355(6):602-11.
(14) Engebretsen KM, Kaczmarek KM, Morgan J, Holger JS. High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning. Clin Toxicol (Phila) 2011; 49(4):277-83.
(15) Kline JA, Raymond RM, Leonova ED, Williams TC, Watts JA. Insulin improves heart function and metabolism during non-ischemic cardiogenic shock in awake canines. Cardiovasc Res 1997; 34(2):289-98.
(16) Boyer EW, Shannon M. Treatment of calcium-channel-blocker intoxication with insulin infusion. N Engl J Med 2001; 344(22):1721-2.
(17) Greene SL, Gawarammana I, Wood DM, Jones AL, Dargan PI. Relative safety of hyperinsulinaemia/euglycaemia therapy in the management of calcium channel blocker overdose: a prospective observational study. Intensive Care Med 2007; 33(11):2019-24.
(18) Varpula T, Rapola J, Sallisalmi M, Kurola J. Treatment of serious calcium channel blocker overdose with levosimendan, a calcium sensitizer. Anesth Analg 2009; 108(3):790-2.
(19) Osthoff M, Bernsmeier C, Marsch SC, Hunziker PR. Levosimendan as treatment option in severe verapamil intoxication: a case report and review of the literature. Case Report Med 2010; 2010. pii: 546904. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931406/pdf/CRM2010-546904.pdf. Consulta: 10 marzo 2012.
Published
2012-09-30
How to Cite
1.
Angulo M, Grille P, Albornoz H, Álvez JI, Bagnulo H. Calcium channel blockers severe poisoning. Rev. Méd. Urug. [Internet]. 2012Sep.30 [cited 2024May18];28(3):225-31. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/345
Section
Clinical Cases
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