This handout is for calcium channel blocker overdose. Your care team identified this based on: reported / suspected verapamil, diltiazem, amlodipine, nifedipine ingestion (acmt 2017).
Other reasons your team may use this plan: bradycardia + hypotension in a patient on or with access to a ccb (crit care 2023); hyperglycemia + shock without diabetic ketoacidosis — ccb until proven otherwise (st-onge crit care med 2017); undifferentiated cardiogenic / vasodilatory shock with toxicologic history (aact/acmt).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| calcium gluconate | 30–60 mL of 10% (3–6 g) IV over 5–10 min; repeat q10–20 min ×3–4 PRN, then infusion 0.6–1.5 mL/kg/h of 10% titrated to ionized calcium / hemodynamics | IV | bolus then continuous infusion | ACMT 2017 — first antidote; overcomes channel blockade by raising extracellular calcium gradient. Gluconate preferred when only peripheral access (less caustic on extravasation). Target ionized Ca up to ~2× normal; surveil for hypercalcemia (Crit Care 2023) |
| calcium chloride | 10–20 mL of 10% (1–2 g) IV via CENTRAL line over 5–10 min; repeat q10–20 min PRN then infusion | IV (central) | bolus then continuous infusion | 3× elemental calcium per mL vs gluconate — preferred in severe shock when central access exists; vesicant, central line mandatory (ACMT 2017) |
| whole-bowel irrigation (polyethylene glycol) | PEG-ELS 1–2 L/h (adult) / 25 mL/kg/h (peds) NG until rectal effluent clear | PO/NG | continuous until effluent clear | ACMT 2017 — SR verapamil/diltiazem form pharmacobezoars; WBI limits ongoing absorption. Activated charcoal 1 g/kg if early and airway protected. Hold if ileus / unprotected airway (Crit Care 2023) |
Plan: CCB overdose — antidotal ladder (calcium → HIET core inotrope → vasopressor → lipid / methylene blue → mechanical support)
Call 911 or go to the nearest emergency room right away if you have:
Wean HIET (taper as glucose tolerance falls — risk of hypoglycemia on abrupt stop), de-escalate vasopressors/calcium; psychiatry + safety planning if intentional; medication-safety / lethal-means counselling; pediatric poison-prevention education and Poison Control reporting (AACT/ACMT)
Guideline: ACMT 2017 Position Statement: Interim Guidance for the Use of High-Dose Insulin and Lipid Emulsion in CCB/BB Poisoning + St-Onge et al. Crit Care Med 2017 (Experts Consensus / systematic review on CCB-poisoning management) + AACT/ACMT Lipid Emulsion Workgroup + 2023 Critical Care narrative review of CCB/BB toxicity + ELSO ECPR guidance