Case Report
Management of Calcium Channel Antagonist Overdose with Hyperinsulinemia-Euglycemia Therapy: Case Series and Review of the Literature
Table 2
Typical treatment modalities.
| (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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