<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0872-671X</journal-id>
<journal-title><![CDATA[Medicina Interna]]></journal-title>
<abbrev-journal-title><![CDATA[Medicina Interna]]></abbrev-journal-title>
<issn>0872-671X</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Medicina Interna]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0872-671X2023000100016</article-id>
<article-id pub-id-type="doi">10.24950/rspmi.1057</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Gestão da Intoxicação por Bloqueadores de Canais de Cálcio]]></article-title>
<article-title xml:lang="en"><![CDATA[Management of Calcium Channel Blockers Poisoning]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Araújo]]></surname>
<given-names><![CDATA[Rita Pinto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Costa]]></surname>
<given-names><![CDATA[Rita Soares]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cunha]]></surname>
<given-names><![CDATA[João Campos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pacheco]]></surname>
<given-names><![CDATA[Maria]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Meireles]]></surname>
<given-names><![CDATA[Elsa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Carvalho]]></surname>
<given-names><![CDATA[João]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pinho]]></surname>
<given-names><![CDATA[Ricardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Hospitalar de Entre-o-Douro e Vouga  Serviço de Medicina Interna]]></institution>
<addr-line><![CDATA[Santa Maria da Feira ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Unidade de Saúde Local da Guarda Serviço de Medicina Interna ]]></institution>
<addr-line><![CDATA[Guarda ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Centro Hospitalar de Entre-o-Douro e Vouga Serviço de Medicina Interna Polivalente ]]></institution>
<addr-line><![CDATA[Santa Maria da Feira ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2023</year>
</pub-date>
<volume>30</volume>
<numero>1</numero>
<fpage>16</fpage>
<lpage>20</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S0872-671X2023000100016&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S0872-671X2023000100016&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S0872-671X2023000100016&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo A intoxicação por bloqueadores de canais de cálcio é geralmente subestimada, sendo uma condição potencialmente life-threatening pelos seus efeitos hemodinâmicos graves. Dependendo da idade, comorbilidades, co-ingestão de outros medicamentos e da magnitude da ingestão tóxica, a apresentação pode variar desde assintomática até choque. Altas doses de insulina parecem ser uma terapêutica adjuvante eficaz, apesar da inexistência de estudos randomizados. Este artigo relata uma série de casos de intoxicação voluntária por bloqueadores de canais de cálcio com melhoria clínica após tratamento com altas doses de insulina. Os doentes eram jovens e sem comorbilidades importantes. A amlodipina foi o fármaco utilizado e, em dois casos, houve co-ingestão de outros fármacos. À admissão todos apresentavam hipotensão refratária à reposição volémica com consequente necessidade de introdução de suporte vasopressor. Altas doses de insulina foram iniciadas precocemente, com uma perfusão média de 0,67 U/kg/h, o que permitiu uma redução sustentada na dose de vasopressores. A hipocaliemia e a hipoglicemia foram frequentes, embora sem gravidade. Concluindo, é fundamental que os profissionais de saúde saibam reconhecer e gerir estas situações clínicas dado o seu elevado risco de mortalidade. Altas doses de insulina parecem ser uma terapêutica viável e segura nestes doentes, desde que seja assegurada uma monitorização intensiva.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract 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.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Bloqueadores de Canais de Cálcio/intoxicação]]></kwd>
<kwd lng="pt"><![CDATA[Insulina/administração e dosagem]]></kwd>
<kwd lng="pt"><![CDATA[Sobredosagem de Medicamento/tratamento farmacológico]]></kwd>
<kwd lng="pt"><![CDATA[Tratamento de Emergência.]]></kwd>
<kwd lng="en"><![CDATA[Calcium Drug Overdose/drug therapy]]></kwd>
<kwd lng="en"><![CDATA[Emergency Treatment]]></kwd>
<kwd lng="en"><![CDATA[Insulin/administration &amp; dosage.]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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