Calcium channel blocker toxicity

Source: Wikipedia, the free encyclopedia.
Calcium channel blocker toxicity
Other namesCalcium channel blocker poisoning, calcium channel blocker overdose
vasopressors, lipid emulsion[1][2]
PrognosisHigh risk of death[2]
Frequency> 10,000 (US)[2]

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.[3] This often causes a slow heart rate and low blood pressure.[1] This can progress to the heart stopping altogether.[2] Some CCBs can also cause a fast heart rate as a result of the low blood pressure.[4] Other symptoms may include nausea, vomiting, sleepiness, and shortness of breath.[2] Symptoms usually occur in the first six hours but with some forms of the medication may not start until 24 after hours.[2]

There are a number of treatments that may be useful.

vasopressors and lipid emulsion.[1][2] Extracorporeal membrane oxygenation may also be an option.[1]

More than ten thousand cases of calcium channel blocker toxicity were reported in the United States in 2010.

beta blockers and digoxin calcium channel blockers have one of the highest rates of death in overdose.[2] These medications first became available in the 1970s and 1980s.[2] They are one of the few types of medication in which one pill can result in the death of a child.[2]

Signs and symptoms

Most people who have taken too much of a calcium channel blocker, especially

reflex tachycardia as a reaction to the low blood pressure.[4][5][6]

Other potential symptoms include: nausea and vomiting, a decreased level of consciousness, and breathing difficulties.

Hypocalcaemia may also occur.[7]

Cause

Calcium channel blockers, also known as calcium channel antagonists, are widely used for a number of health conditions.[8] Thus they are commonly present in many people's homes. In young children one pill may cause serious health problems and potentially death.[8] The calcium channel blocker that caused the greatest number of deaths in 2010 in the United States was verapamil.[2] This agent is believed to cause more heart problems than many of the others.[2]

Diagnosis

A blood or urine test to diagnose overdose is not generally available.[2] CCB overdose may cause high blood sugar levels, and this is often a sign of how severe the problem will become.[1]

Electrocardiogram

CCB toxicity can cause a number of

QT prolongation, bundle branch block, first-degree atrioventricular block, and even sinus tachycardia.[1]

Differential

It may not be possible to tell the difference between

beta blocker toxicity and calcium channel blocker overdose based on signs and symptoms.[1]

Management

The medical management of CCB toxicity may be difficult.[1] It may not improve with the usual treatments used for a low blood pressure and a slow heart rate.[9] Those who have no symptoms or signs six hours following taking an immediate release formulation and 24 hours after taking an extended release formulation generally need no further medical treatment.[2]

Detoxification

Activated charcoal is recommended if it can be given within an hour or two of taking the calcium channel blockers.[1] In those who have taken an extended release formulation of a CCB but are otherwise doing fine, whole bowel irrigation with polyethylene glycol may be useful.[1] Causing vomiting by the use of medications such as ipecac is not recommended.[1]

Insulin

High doses of

intravenous insulin with glucose may be useful and are a first line treatment in overdoses.[1][10] As this treatment may cause a drop in blood sugar and blood potassium levels, these should be monitored closely.[11]

Other

Intravenous

sympathomimetics. Low blood pressure is treated with vasopressors such as adrenaline.[6][13]

There is tentative clinical evidence and good theoretical evidence of the benefit of lipid emulsion in severe overdoses of CCBs.[14] Methylene blue may also be used for those with low blood pressure that does not respond to other treatments.[10]

Epidemiology

More than 10,000 cases of potential calcium channel blocker toxicity occurred in the United States in 2010.[2] When death occurs in medicine overdose, heart medications are the cause more than 10% of time.[2] The three most common types of heart medications that result in this outcome are calcium channel blockers along with beta blockers and digoxin.[2]

References

  1. ^
    PMID 24883458. Archived
    from the original on 2014-05-14.
  2. ^
    ISBN 978-1455706051
    .
  3. ^ a b "Calcium channel blocker overdose". ADAM. 2011-01-19. Archived from the original on 5 April 2014. Retrieved 9 May 2014.
  4. ^
    ISBN 9780781789431. Archived
    from the original on 15 August 2016. Retrieved 28 July 2016.
  5. ISBN 978-3-8047-2898-1
    .
  6. ^ a b Haberfeld, H, ed. (2015). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. Adalat; Norvasc; Sibelium; Zanidip.
  7. PMID 20956045
    .
  8. ^
    ISBN 978-0071668330
    .
  9. PMID 16990629
    .
  10. ^
    PMID 26344579
    .
  11. S2CID 32138463
    .
  12. ^ "Calcium channel blocker poisoning". UpToDate. Retrieved 2019-07-09.
  13. ^ Haberfeld, H, ed. (2015). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. Verapabene.
  14. PMID 20923546
    .

External links
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