Management of Serious Calcium Channel Blocker Overdose in Adults
Normal saline bolus (10–20 mL/kg)
Correct pH
10% calcium chloride, 5–10 mL, or 10% calcium gluconate, 10–20 mL, over 5 minutes
- Repeat every 3–5 minutes, up to three to five doses
- If response, institute calcium infusion (10% calcium chloride, 1–10 mL/hour)
- Monitor serum calcium after 30 mL of calcium chloride or equivalent
Atropine, isoprenaline (isoproterenol) and/or pacing may be tried if associated symptomatic bradycardia
Dopamine infusion if persistent hypotension
Begin insulin euglycaemia therapy in any patient whose resuscitation requires more than just IV fluids as there is normally a delay in effect
Insulin bolus, 1 unit/kg with glucose, 50% dextrose, 25 ml i.v.
followed by
Insulin infusion, 0.5 units/kg/hour with 50% dextrose infusion, 0.5 g/hour, adjusted according to hourly glucose checks
Monitor potassium
As a last resort, extracorporeal blood pressure support (e.g. cardiopulmonary bypass) may be considered