EMCrit Podcast EMCrit Podcast 27 – Calcium Channel Blocker Overdose
Oct 12, 2010
Leon Gussow, board-certified emergency and internal medicine physician and toxicology educator who runs The Poison Review. He walks through initial ABCs and monitoring for calcium channel blocker overdoses. They compare calcium formulations and antidotes, explain classes and presentations, and focus on vasopressors, high-dose insulin therapy and practical dosing, glucose and potassium management, and rescue mechanical support options.
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Give Calcium Early But Don't Rely On It
- Give calcium (eg, 1 g calcium chloride or 3 g calcium gluconate) early but expect variable and often limited hemodynamic effect.
- Use calcium chloride for rapid effect if IV is robust; avoid small peripheral lines due to tissue necrosis risk.
CCB Class Predicts Heart Versus Vascular Effects
- Different CCB classes produce different hemodynamic pictures: verapamil (phenylalkylamine) hits heart strongly while dihydropyridines like amlodipine primarily vasodilate.
- Leon Gussow treats overdoses similarly but warns amlodipine cases may be tachycardic, not bradycardic.
Start High Dose Insulin Early As Specific Antidote
- Start high-dose insulin early for severe CCB toxicity: bolus 1 U/kg IV followed by infusion 0.5 U/kg/hr, titratable up to 1 U/kg/hr.
- Begin insulin while pressors are running because metabolic antidote effect takes ~30–45 minutes.