How to manage calcium channel blocker toxicity?
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Hello, how to manage calcium channel blocker toxicity? Calcium channel blockers (CCBs) are among the most commonly used cardiovascular drugs in the adult population. Like most other medications, when calcium channel blockers are taken beyond the appropriate recommended dosage, they can have untoward toxicities with a wide range of complications that can even be fatal. Please leave your comments.
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@moucheta The basic tenets of critically ill patient management remain focused on initial attention to airway, breathing, and circulations. Consider endotracheal intubation in patients with worsening signs and symptoms of toxicity due to the risk of rapid hemodynamic deterioration — some advocate pre-administration of atropine to offset vagally mediated hypotension and bradycardia during laryngoscopy. If rapid deterioration is not evident, the patient should still be on a continuous cardiac monitor with close, intensive care monitoring. History should focus on underlying medical conditions, type of formulation ingested (immediate vs. sustained release), co-ingestants, and time of ingestion. Obtain an ECG to identify conduction abnormalities. Atropine is mostly ineffective in severe CCB toxicity. Use intravenous crystalloids during initial resuscitation while remaining cognizant of the risk of fluid overload with drug-induced inotropic failure. Therefore, dynamic assessment of fluid responsiveness with pulse pressure variability or stroke volume variability may be worthwhile.