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Beta blocker overdose antidote4/10/2023 Animal models have suggested some success in verapamil overdose but PDEI remain a second-line treatment. ![]() ![]() Similar principles apply with regard to CCB overdose and the same concerns remain with regard to excessive tachycardia and hypotension. Phosphodiesterase inhibitors have been discussed for beta-blocker overdose. ![]() 115,116 Case reports are mixed some support the use of glucagon 103,116 while others have demonstrated its failure to have an impact on blood pressure or heart rate with CCB overdose. It has been shown to reverse bradycardia and hypotension induced by diltiazem, nifedipine, and verapamil in isolated heart preparations 114 and to increase the heart rate and contractility following verapamil infusion in intact animal studies. Glucagon therapy in CCB overdose is well supported by laboratory data. 112,113 The beneficial effects of calcium are more likely to be seen in cases of impaired inotropy therefore it is unlikely to be effective in patients with shock secondary to vasodilatation or in cases with severe bradycardia or AV block. 103 Calcium treatment has failed to show an effect in other cases. Twenty-three patients were treated with calcium in a large case series of CCB overdose 16 (70%) showed an increase in blood pressure in response. However, solid clinical evidence is sparse. Metabolic acidosis, elevated lactate, hyperglycemia, and pulmonary edema are all more frequent in CCB overdose and investigations should be prioritized to reflect these.Īs with beta-blocker overdose, calcium is a logical therapy for CCB toxicity. Patients should receive the same basic assessment, investigations, and treatment to include airway and ventilator support, gut decontamination if appropriate, and fluid resuscitation. The management of acute CCB toxicity shares many of the principles of beta-blocker poisoning and readers should consult the section on the management of beta-blocker toxicity. Ponniah Thirumalaikolundusubramanian, in Heart and Toxins, 2015 8.8.1 Management of CCB Toxicity
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