In light of the variable pharmacokinetics among the available CCBs ( 6, 7), the altered pharmacokinetics following overdose ( 8, 9) and the loss of selectivity at very high CCB doses ( 10, 11), the workgroup adopted a pragmatic clinical approach and did not focus on individual agents (for complementary information concerning CCB poisoning, see Appendix 1, Supplemental Digital Content 1, ).Īnalytical framework for calcium channel blocker (CCB) poisoning treatment guidelines. Considering the very low level of evidence found in the literature, the workgroup agreed on developing expert consensus recommendations to propose a management approach and facilitate knowledge translation. In the absence of formally recognized guidelines, we convened a workgroup of experts involved in the care of poisoned patients to develop evidence-based recommendations to guide the in-hospital management of CCB poisoning. Consensus recommendations were published for out-of-hospital management of calcium channel blocker (CCB) ingestion ( 5), but recommendations for in-hospital care have not been systematically developed. Furthermore, the advice given by poison control centers are often not followed ( 2– 4). Toxicity from cardiac drugs is associated with a large number of fatalities and significant morbidity ( 1, 2). We suggest venoarterial extracorporeal membrane oxygenation, if available, when refractory shock has a significant cardiogenic component (2D), and using pacemaker in the presence of unstable bradycardia or high-grade arteriovenous block in the absence of myocardial dysfunction (2D) if not already tried 5) in patients with cardiac arrest, we recommend IV calcium in addition to the standard advanced cardiac life-support (1D), lipid-emulsion therapy (1D), and we suggest venoarterial extracorporeal membrane oxygenation if available (2D). We also suggest dobutamine or epinephrine in the presence of cardiogenic shock (2D) and atropine in the presence of symptomatic bradycardia or conduction disturbance (2D) 3) in patients refractory to the first-line treatments, we suggest incremental doses of high-dose insulin therapy if myocardial dysfunction is present (2D), IV lipid-emulsion therapy (2D), and using a pacemaker in the presence of unstable bradycardia or high-grade arteriovenous block without significant alteration in cardiac inotropism (2D) 4) in patients with refractory shock or who are periarrest, we recommend incremental doses of high-dose insulin (1D) and IV lipid-emulsion therapy (1D) if not already tried.
We recommend 1) for asymptomatic patients, observation and consideration of decontamination following a potentially toxic calcium channel blocker ingestion (1D) 2) as first-line therapies (prioritized based on desired effect), IV calcium (1D), high-dose insulin therapy (1D–2D), and norepinephrine and/or epinephrine (1D).
0 kommentar(er)
