1. See WikiTox link above for an in-depth review
2. Listen to EMRAP (Ca++ & B-blocker OD) - https://www.emrap.org/episode/2010/december/calciumandbeta?emrap=grogkfcge2l7e00pncgiumera4
3. Listen & Read EMCRIT - http://emcrit.org/podcasts/calcium-channel-blocker-od/
- Activated Charcoal x 1
- Whole bowel-Irrigation is not recommended by Leon’s group
- Frequent glucose and k checks
- Atropine (can try it once, but it will limit gastric motility and probably won’t work)
- Calcium, 1 g of CaCl or 3 g of CaGluc. Give slowly over 3 minutes for CaCl and 10 min for CaGluc.
- Glucagon 5 mg bolus, probably won’t do much, unlike in beta blocker OD
- High Dose Insulin. Start with 1 unit/kg push followed by 0.5-1 unit/kg/hr. Fingersticks q30 minutes and adequate glucose replacement if needed. Check potassium; supplement if < 2.5. (Crit Care 2006;10:212)
- May need to use norepinephrine or dopamine (alternatively Epi). May need much higher doses of epi or norepi. Dopamine must be stopped at 20 mcg/kg/min, which is kind of a joke in this OD. Switch to one of the others if you get this high.
- Levosimendan may have a role, but not available in the US.
- IABP, CP Bypass