There are many different types of calcium channels, but our focus here is the L-type channel. 1 Approximately 40% of each were unintentional exposures, and 14% involved children younger than age 6. Of these exposures, 707 beta-blocker and 423 calcium channel blocker cases had 'moderate' to 'severe' outcomes, and there were 6 beta-blocker and 12 calcium channel blocker deaths reported. In 2008, the American Association of Poison Control Centers in the Toxic Exposure Surveillance System Database recorded 21,282 exposures to beta-blockers and 10,398 exposures to calcium channel blockers. When signs or symptoms do develop, there are many therapeutic options. It is important for an emergency physician to be aware of the potential severity of an overdose. When misused, either intentionally or unintentionally, the effects can be life-threatening.

In the emergency department, we are all aware of these medications for the treatment of hypertension, heart failure, atrial fibrillation, and a variety of other illnesses. The resident says the child looks great and is playing in the room and then asks you, 'Are three tablets a big deal? Can we just watch the child for a couple of hours? Do we need an IV and blood work? Since there is no pediatric unit here, should we consider transfer now?'īeta-blockers and calcium channel blockers are very widely prescribed cardiovascular medications. The grandmother thinks that at most there are three tablets missing. Meanwhile, the resident working with you pulls you aside to tell you about a 2-year-old child in the pediatric area who was found playing with grandma's bottle of verapamil controlled release 15 minutes ago. You wonder, 'Is it too late for gastric decontamination? If he is symptomatic, which therapy will I try first, and what are my options?'

The patient is lethargic but arousable, and reports he took about 40 tablets of immediate-release metoprolol three hours ago in an attempt to 'end it all.' The nurses are starting IV lines, checking vitals, and putting the patient on the monitor. The patient has a history of hypertension, atrial fibrillation, and depression. You have just taken sign-out when a nurse comes up to you and says that there is a 64-year-old man in the critical bay who took an overdose of his medications.

Weiselberg, MD, North Shore University Hospital, Department of Emergency Medicine, Medical Toxicology, Manhasset, NY.įrank LoVecchio, DO, Director, Banner Poison Center, Maricopa Medical Center, Phoenix, AZ. Mark Su, MD, North Shore University Hospital, Department of Emergency Medicine, Medical Toxicology, Manhasset, NY. An Evidence-based Approach to Beta-Blocker and Calcium Channel Blocker Toxicity

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