Are vasopressors effective therapy in calcium channel blocker overdose?

4 out of 5 stars Critical Care Management of Verapamil and Diltiazem Overdose with a Focus on Vasopressors: A 25-Year Experience at a Single Center. Levine M et al. Ann Emerg Med 2013 May 1 {Epub ahead of print] Abstract This uncommonly interesting and thought-provoking study comes from the Department of Medical Toxicology at Banner Good Samaritan Medical Center in Phoenix. The authors note that in recent years, many toxicologists have suggested that hyperinsulinemic euglycemic therapy (HIT) is superior to vasopressors in the treatment of calcium channel blocker (CCB) toxicity. However, there have been no studies comparing the two modes of treatment. At the authors’ institution — one that includes an in-hospital toxicology service — administration of high-dose vasopressors is a mainstay of treating these cases, and HIT apparently somewhat de-emphasized. To evaluate their perception that patients who present with CCB overdose almost always respond well to vasopressors, the authors retrospectively reviewed their experience of 25 years (1987 through 2012) with patients > 14 years of age who had laboratory-confirmed overdose to verapamil or diltiazem. They identified 48 eligible patients, half with exposure to verapamil. Three patients received HIT, along with multiple vasopressors. In total, 33 patients received vasopressors (median 2 drugs, range 1-5). Maximum infusion rates included norepinephrine 100 μg/min, dopamine 100 μg/kg/min, epinephrine 150 μg/min,...
Source: The Poison Review - Category: Toxicology Authors: Tags: Best of TPR Medical calcium channel blocker toxicity diltiazem hyperinsulinemic euglycemic therapy verapamil Source Type: news