Calcium channel blocker toxicity

Calcium channel blocker toxicity is the taking of too much of the medications known as calcium channel blockers (CCBs), either by accident or on purpose. This often causes a slow heart rate and low blood pressure. This can progress to the heart stopping altogether. Some CCBs can also cause a fast heart rate as a result of the low blood pressure. Other symptoms may include nausea, vomiting, sleepiness, and shortness of breath. Symptoms usually occur in the first six hours but with some forms of the medication may not start until 24 after hours.

Calcium channel blocker toxicity
Other namesCalcium channel blocker poisoning, calcium channel blocker overdose
A 20% lipid emulsion commonly used for calcium channel blocker toxicity
SpecialtyEmergency medicine
SymptomsSlow heart rate, low blood pressure, nausea, vomiting, sleepiness
ComplicationsCardiac arrest
Usual onsetWithin 6 hours
CausesToo much calcium channel blockers either by accident or on purpose
Differential diagnosisBeta blocker toxicity
TreatmentActivated charcoal, whole bowel irrigation, intravenous fluids, calcium gluconate, glucagon, high dose insulin, vasopressors, lipid emulsion
PrognosisHigh risk of death
Frequency> 10,000 (US)

There are a number of treatments that may be useful. These include efforts to reduce absorption of the drug including: activated charcoal taken by mouth if given shortly after the ingestion or whole bowel irrigation if an extended release formula was taken. Efforts to bring about vomiting are not recommended. Medications to treat the toxic effects include: intravenous fluids, calcium gluconate, glucagon, high dose insulin, vasopressors and lipid emulsion. Extracorporeal membrane oxygenation may also be an option.

More than ten thousand cases of calcium channel blocker toxicity were reported in the United States in 2010. Along with beta blockers and digoxin calcium channel blockers have one of the highest rates of death in overdose. These medications first became available in the 1970s and 1980s. They are one of the few types of medication in which one pill can result in the death of a child.

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