management

Last reviewed 01/2018

The protein binding of calcium channel blockers means that techniques such as haemofiltration and dialysis are of no benefit.

Initial treatment should be gastric lavage and the administration of activated charcoal. If large amounts of drug have been taken then complete gut lavage should be considered.

Although hypotension is often resistant to fluid infusion, hydration should be maintained with 0.9% saline i.v.

Cardiac function may improve with the administration of calcium chloride:

• give 10% calcium chloride i.v. over 5 min
• the dose is 0.2 ml/kg (maximum of 10 ml)
• may be repeated every 20 min up to a maximum of 4 times

Glucagon (10 mg i.v.) may have a positive chrono- and ino- tropic effect.

Resistent hypotension may require vasopressor agents such as isoprenaline or dopamine.

Pulmonary oedema is usually cardiogenic. It may respond to diuretics.

An intra-aortic balloon or extracorporeal circulation are interventions of last resort.

Rarely, hyperglycaemia will require insulin therapy.