Abstract

ARAUJO, Rita Pinto et al. Management of Calcium Channel Blockers Poisoning. Medicina Interna [online]. 2023, vol.30, n.1, pp.16-20.  Epub Mar 10, 2023. ISSN 0872-671X.  https://doi.org/10.24950/rspmi.1057.

Calcium channel blockers poisoning is generally underestimated, although being a potential life-threatening condition due to its severe hemodynamic effects. Depending on age, comorbidities, co-ingestion of other medications and the magnitude of toxic ingestion, clinical presentation can range from asymptomatic to shock. High dose insulin seems to be an effective adjunctive therapy, despite the lack of randomized studies. We report a series of cases of calcium channel blockers voluntary intoxication with clinical improvement after treatment with high dose insulin. Patients were young and without major comorbidities. Amlodipine was the drug used and, in two cases, there was co-ingestion of other drugs. At admission, despite volume replacement, all patients had persistent hypotension requiring vasopressor support. High dose insulin perfusion was started early, with a mean infusion of 0.67 U/kg/h, which allowed a sustained reduction in vaso-pressor dose. Hypokalemia and hypoglycemia were frequent, but without severity. In conclusion, it is essential that health professionals know how to recognize and manage these clinical situations given its high risk of mortality. High dose insulin seems to be a viable and safe therapy in these patients as long as intensive monitoring is guaranteed.

Keywords : Calcium Drug Overdose/drug therapy; Emergency Treatment; Insulin/administration & dosage..

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