Management of Calcium Channel Antagonist Overdose with Hyperinsulinemia-Euglycemia Therapy: Case Series and Review of the Literature

Table 2

Typical treatment modalities.

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(1) Decontamination/supportive therapy:

 (a) activated charcoal: single dose of 50 g for adults;

 (b) polyethylene glycol whole bowel irrigation: 2L/hr in adults until rectal effluent is clear;

 (c) intravenous fluids;

 (d) atropine: 1 mg IV (can be repeated up to 3 mg total).

(2) Antidotes:

 (a) calcium salts:

  (i) calcium chloride: 10–20 mL of a 10% solution administered over 10 min (can repeat dose if no effect);

  (ii) calcium gluconate: 30–60 mL of a 10% solution (dose can be repeated if no effect);

  (iii) continuous infusion with either salt: 0.5 meq of Ca/kg/hr;

 (b) glucagon: 5 mg IV bolus, can be repeated twice at 10 min intervals.

(3) PDI (e.g., amrinone and milrinone).

(4) Adrenergic agents (e.g., norepinephrine and dopamine, etc.).

(5) HIE:

 (a) regular insulin bolus of 0.1 U/kg IV and then continuous infusion of 0.2–0.5 U/kg/hr;

 (b) dextrose 25 to 50 g bolus followed by a continuous infusion of 0.5 g glucose/kg/hr that can be titrated to appropriate blood glucose.

(6) Invasive therapy:

 (a) transvenous pacing;

 (b) intraaortic balloon pump;

 (c) cardiopulmonary bypass;

 (d) extracorporeal membrane oxygenation.

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