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• W2980917526 abstract "SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Calcium channel blockers (CCBs) are widely used for the treatment of hypertension, angina, and arrhythmias. When high amounts are ingested, they can cause severe hemodynamic instability and ultimately death. According to the 2016 annual report of the American Association of Poison Control Centers (AAPCC), intoxication with CCBs accounts for only a small percent of all cardiovascular drug exposures but the number of deaths related to their ingestion is higher compared to other cardiovascular agents. We report a case of a successfully treated massive CCBs overdose. CASE PRESENTATION: A 23-year-old man with a history of schizophrenia was brought to the emergency room after a suicidal attempt. According to his mother, he took more than one hundred tablets of amlodipine and an unspecified number of levothyroxine and meclizine tablets. Upon presentation, the patient was tachycardic with a heart rate of 136 beats per minute but normotensive and in no acute distress. However, he quickly became hypotensive with a blood pressure of 86/31 mmHg and a mean arterial pressure of 49 mmHg. Laboratory workup was unremarkable. He was admitted to the intensive care unit (ICU) where intravenous (IV) fluids and vasopressor support with norepinephrine were started. The patient developed refractory hypotension within the next few hours despite the addition of epinephrine and vasopressin. AAPCC was contacted and per their recommendations, high-dose IV regular insulin (1 unit/kg/hr) and fifty percent IV dextrose were started. Hospitalization was complicated by pulmonary edema and significant respiratory distress, but he did not require invasive mechanical ventilation. His hemodynamic status improved progressively and four days later he was taken off vasopressors and IV insulin. A psychiatric evaluation was performed, and the patient was transferred out of the ICU. DISCUSSION: CCBs intoxication is associated with a large number of fatalities and significant morbidity; therefore prompt therapy plays an important role in the patient’s outcome. Hypotension, bradycardia, and cardiogenic shock are characteristic features. Available therapies for the management of CCBs intoxication are very broad and include supportive therapy with IV fluids, activated charcoal, IV calcium salts, IV glucagon, IV high-dose insulin, IV lipid emulsion therapy, and IV vasopressor support. Treatment is usually dictated by the clinical presentation of the patient, but choosing an adequate therapy is challenging as there are no formally recognized guidelines for the treatment of CCBs overdose. CONCLUSIONS: The lack of targeted therapy makes the management of patients with CCB's poisoning very difficult. Some studies suggest high-dose insulin is superior to conventional therapies in patients with significant hemodynamic instability. Controlled clinical trials are needed to evaluate currently recommended antidotes or to assess new ones. Reference #1: David D. Gummin, James B. Mowry, Daniel A. Spyker, Daniel E. Brooks, Michael O. Fraser, William Banner. (2017) 2016 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th Annual Report. Clinical Toxicology 55:10, pages 1072-1254. Reference #2: St-Onge M1, Dubé PA, Gosselin S, Guimont C, Godwin J, Archambault PM, Chauny JM, Frenette AJ, Darveau M, Le Sage N, Poitras J, Provencher J, Juurlink DN, Blais R. Treatment for calcium channel blocker poisoning: a systematic review. Clin Toxicol (Phila). 2014 Nov;52(9):926-44. Reference #3: Engebretsen KM1, Kaczmarek KM, Morgan J, Holger JS. High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning. Clin Toxicol (Phila). 2011 Apr;49(4):277-83. DISCLOSURES: No relevant relationships by Meily Arevalo, source=Web Response No relevant relationships by Genanew Bedanie, source=Web Response No relevant relationships by Cinthya Carrasco Barcenas, source=Web Response No relevant relationships by Kenneth Nugent, source=Web Response No relevant relationships by David Sotello Aviles, source=Web Response No relevant relationships by Wasawat Vutthikraivit, source=Web Response" @default.
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• W2980917526 date "2019-10-01" @default.
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• W2980917526 title "SUCCESSFUL MANAGEMENT OF MASSIVE CALCIUM CHANNEL BLOCKER OVERDOSE WITH HIGH-DOSE IV INSULIN: A CASE REPORT" @default.
• W2980917526 doi "https://doi.org/10.1016/j.chest.2019.08.1962" @default.
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