ccb overdose

CCB overdose -diltiazem and verapamil are the most cardiotoxic of CCB -5-10 times of usual dose may develop severe intoxication, such as drowsiness and confusion, vs may include hypotension and bradycardia, JVD, pulmonary crackles and other sign of heart failure -ECG changes PR interval prolongation and any bradydysrrhythmia finger stick may reveal hyperglycemia treatment: GI decontamination, including gastric lavage IV calcium, glucagon, high dose insulin therapy, lipid emulsion transvenous pacemaker, intraaortic balloon pump and extracorporeal membrance oxygenation for severe poisoned. 1, assess and stabilize airway, breathing and circulation 2, iv crystalloid, isotonic saline 500 to 1000ml boluses 3, bradycardia treat w/ atropine, repeat for 3 total doses 4, iv calcium for hypotension and/or bradycardia, bolus, calcium chloride 10-20ml of 10% solution via central line, calcium gluconate 30-60 ml of 10% solution cont infusion of 0.5 meq calcium/kg per hour and monitor serum calcium and ECG for evidence of hypercalcemia 5, glucagon for bradycardia, bolus therapy 1-5mg iv push, may repeat up to 15mg 6, vasopressor, norepinephrine 2mcg/min iv, titrate rapidly to systolic blood pressure 100mg 7, bolus insulin 1unit/kg iv, dextrose 25-50g iv, repeat for hypoglycemia, give potassium for hypokalemia 8, GI decontamination: activated charcoal 1g/kg up to 50g 9, consider following therapies if above fail: transvenous cardiac pacing, intraaortic balloon pump, cardiopulmonary bypass, extracorporeal membrane oxygenation