TY  - JOUR
PY  - 2016//
TI  - Experts consensus recommendations for the management of calcium channel blocker poisoning in adults
JO  - Critical care medicine
A1  - St-Onge, Maude
A1  - Anseeuw, Kurt
A1  - Cantrell, Frank Lee
A1  - Gilchrist, Ian C.
A1  - Hantson, Philippe
A1  - Bailey, Barbara
A1  - Lavergne, Valery
A1  - Gosselin, Sophie
A1  - Kerns, William
A1  - Laliberté, Martin
A1  - Lavonas, Eric J.
A1  - Juurlink, David N.
A1  - Muscedere, John
A1  - Yang, Chen-Chang
A1  - Sinuff, Tasnim
A1  - Rieder, Michael
A1  - Megarbane, Bruno
SP  - e306
EP  - e315
VL  - 45
IS  - 3
N2  - OBJECTIVE: To provide a management approach for adults with calcium channel blocker poisoning. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: Following the Appraisal of Guidelines for Research & Evaluation II instrument, initial voting statements were constructed based on summaries outlining the evidence, risks, and benefits. DATA SYNTHESIS: We recommend 1) for asymptomatic patients, observation and consideration of decontamination following a potentially toxic calcium channel blocker ingestion (1D); 2) as first-line therapies (prioritized based on desired effect), IV calcium (1D), high-dose insulin therapy (1D-2D), and norepinephrine and/or epinephrine (1D). We also suggest dobutamine or epinephrine in the presence of cardiogenic shock (2D) and atropine in the presence of symptomatic bradycardia or conduction disturbance (2D); 3) in patients refractory to the first-line treatments, we suggest incremental doses of high-dose insulin therapy if myocardial dysfunction is present (2D), IV lipid-emulsion therapy (2D), and using a pacemaker in the presence of unstable bradycardia or high-grade arteriovenous block without significant alteration in cardiac inotropism (2D); 4) in patients with refractory shock or who are periarrest, we recommend incremental doses of high-dose insulin (1D) and IV lipid-emulsion therapy (1D) if not already tried. We suggest venoarterial extracorporeal membrane oxygenation, if available, when refractory shock has a significant cardiogenic component (2D), and using pacemaker in the presence of unstable bradycardia or high-grade arteriovenous block in the absence of myocardial dysfunction (2D) if not already tried; 5) in patients with cardiac arrest, we recommend IV calcium in addition to the standard advanced cardiac life-support (1D), lipid-emulsion therapy (1D), and we suggest venoarterial extracorporeal membrane oxygenation if available (2D). <br><br>CONCLUSION: We offer recommendations for the stepwise management of calcium channel blocker toxicity. For all interventions, the level of evidence was very low.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.<p />  <p>Language: en</p>
LA  - en
SN  - 0090-3493
UR  - http://dx.doi.org/10.1097/CCM.0000000000002087
ID  - ref1
ER  -