Abstract
Calcium channel blockers (CCBs) have seen an increase in rate of non-therapeutic exposure
that is both accidental and intentional in nature. Patients experiencing the toxic
effects of a CCB overdose are resource intensive and can quickly outstrip the capabilities
of local health systems, necessitating transfer to larger tertiary or quaternary care
centers. We present a case of intentional non-dihydropyridine CCB overdose and toxicity
in a 20-year-old patient requiring initial stabilization at a referring critical access
emergency department with continuation of treatment and support during a 60-minute
rotor wing transport from the referring hospital to an academic quaternary care center.
Emphasis is placed on the unique challenges in resuscitation and ongoing critical
care administration during the transport phase of care. Proper stabilization of patients,
planning, and consideration of potential problems associated with transport can help
minimize stresses and risk of the transport, improving the outcome of extremely ill
patients even under challenging circumstances.
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References
- 2017 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 35th Annual Report.Clin Toxicol (Phila). 2018; 56: 1213-1415
- Critical care management of verapamil and diltiazem overdose with a focus on vasopressors: a 25-year experience at a single center.Ann Emerg Med. 2013; 62: 252-258
- Experts consensus recommendations for the management of calcium channel blocker poisoning in adults.Crit Care Med. 2017; 45: e306-e315
- 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report [published correction appears in Clin Toxicol [Phila]. 2016;54:607].Clin Toxicol (Phila). 2015; 53: 962-1147
- Adherence to calcium channel blocker poisoning treatment recommendations in two Canadian cities.Clin Toxicol (Phila). 2012; 50: 424-430
- Treatment of amlodipine intoxication with intravenous lipid emulsion therapy: a case report and review of the literature.Cardiovasc Toxicol. 2017; 17: 482-486
- Calcium channel blocker toxicity.Pediatr Emerg Care. 2009; 25: 532-540
- An overview of hyperinsulinemic-euglycemic therapy in calcium channel blocker and β-blocker overdose.Pharmacotherapy. 2018; 38: 1130-1142
- Hyperinsulinemic euglycemia therapy for verapamil poisoning: a review.Am J Crit Care. 2007; 16: 498-503
- Chapter 40. Calcium channel antagonists.in: Olson KR Poisoning & Drug Overdose, 6e. McGraw-Hill, New York, NY2012 (Available at:)https://accessmedicine-mhmedical-com.proxy.lib.umich.edu/content.aspx?bookid=391§ionid=42069854Date accessed: September 23, 2020
- Critical management of severe hypotension caused by amlodipine toxicity managed with hyperinsulinemia/euglycemia therapy supplemented with calcium gluconate, intravenous glucagon and other vasopressor support: review of literature.Cardiol Res. 2018; 9: 46-49
- Patient-ventilator dyssynchrony: clinical significance and implications for practice.Crit Care Nurse. 2009; 29: 41-55
- Monitoring patient-ventilator asynchrony.Curr Opin Crit Care. 2016; 22: 246-253
- Patient-ventilator asynchrony [published correction appears in J Bras Pneumol. 2018 Sep 03].J Bras Pneumol. 2018; 44: 321-333
- A multifaceted approach to calcium channel blocker overdose: a case report and literature review.Clin Case Rep. 2015; 3: 566-569
- Pharmacological and mechanical management of calcium channel blocker toxicity.BMJ Case Rep. 2018; 2018bcr2018225324
- What is the best treatment for acute calcium channel blocker overdose?.Ann Emerg Med. 2013; 62: 259-261
- The recommendation and use of extracorporeal membrane oxygenation (ECMO) in cases reported to the California Poison Control System.J Med Toxicol. 2019; 15: 169-177
- Massive diltiazem overdose treated with extracorporeal membrane oxygenation.Pediatr Crit Care Med. 2003; 4: 372-376
- Massive diltiazem and metoprolol overdose rescued with extracorporeal life support.Am J Emerg Med. 2017; 35: 1581.e3-1581.e5
- Survival after cardiac arrest: ECMO rescue therapy after amlodipine and metoprolol overdose.Cardiovasc Toxicol. 2017; 17: 223-225
- Extracorporeal membrane oxygenation (ECMO) for severe toxicological exposures: review of the Toxicology Investigators Consortium (ToxIC).J Med Toxicol. 2016; 12: 95-99
The Registry of the Extracorporeal Life Support Organization. Available at: www.elso.org Accessed on November 9, 2020.
- Transferring the critically ill patient: are we there yet?.Crit Care. 2015; 19: 62
Article info
Publication history
Published online: December 03, 2020
Identification
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© 2020 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.
