Pharmacological and mechanical management of calcium channel blocker toxicity
Cardiovascular instability associated with calcium channel blocker poisoning comprises a small percentage of all overdose presentations, yet they can deteriorate quickly and they are associated with a high mortality rate. A 64-year old gentleman presented following an intentional overdose of 840 mg nimodipine. We detail the acute management of the patient in the Emergency Department, involving the use of calcium, glucagon, intralipid, high-dose insulin therapy, sodium bicarbonate, vasopressors and methylene blue. We highlight the scarcity of the evidence behind their use as well as exploring the use of electrical pacing and veno-arterial extracorporeal membrane oxygenation (VA-ECMO).
Following successful weaning of VA-ECMO, the patient was successfully extubated but remained neurologically impaired due to hypoxic brain injury and critical care polyneuropathy. He remained off respiratory and cardiovascular support and is undergoing physical rehabilitation.
