A Critical Note on Treatment of a Severe Diltiazem Intoxication: High-Dose Calcium and Glucagon Infusions

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Mathilde Van Veggel1, Gijs Van der Veen2, Tim Jansen2,3

  • 1Department of Pharmacy, Franciscus Gasthuis Hospital, Rotterdam, The Netherlands.

Basic & Clinical Pharmacology & Toxicology
|May 16, 2017
PubMed

Insights

Severe diltiazem intoxication can be life-threatening, causing cardiac issues. High-dose calcium and glucagon infusions may help, but careful monitoring is crucial to avoid complications like pancreatitis.

Area of Science:

  • Cardiology
  • Toxicology
  • Emergency Medicine

Background:

  • Severe calcium channel blocker intoxication presents significant morbidity and mortality.
  • Treatment options are supported by limited, low-quality evidence.
  • Diltiazem intoxication specifically can lead to severe cardiac toxicity.

Observation:

  • A case of severe diltiazem intoxication in a 53-year-old woman presenting with cardiogenic shock and complete AV block is described.
  • The patient did not respond to standard treatments including atropine, isoprenaline, and external pacing.
  • Initial treatment involved fluids, inotropes, vasopressors, high-dose calcium, and glucagon infusions.

Findings:

  • The patient's condition improved with high-dose calcium and glucagon infusions.
  • However, she developed acute necrotizing pancreatitis, likely due to iatrogenic hypercalcemia.
  • There is a lack of consensus on target serum calcium levels for treating diltiazem intoxication.

Implications:

  • Goal-directed calcium tapering is essential to prevent side effects like hypercalcemia.
  • The efficacy of glucagon infusions is questionable due to the instability of solubilized glucagon, potentially explaining variable treatment outcomes.
  • This case highlights the need for further research into optimal treatment strategies for severe calcium channel blocker overdoses.

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