Hyperglycemia and Severe Medical Outcomes in Calcium Channel Blocker Exposures Reported to United States Poison...

Calcium channel blockers (CCBs) antagonize L-type calcium channels, primarily in the cardiovascular system. In overdose, the pancreas also is affected, which prevents the release of insulin leading to hyperglycemia. We sought to determine the incidence of hyperglycemia in CCB exposures reported to US poison centers and to compare the incidence of hyperglycemia with severe medical outcomes.

We performed a retrospective chart review of CCB exposures using data from the National Poison Database System from January 1, 2007, through December 31, 2017. Exposures with co-ingestions were excluded. Statistical analysis was performed to determine incidence of hyperglycemia and associated medical effects. Statistical analyses on age and intentionality of exposure also were performed.

There were a total of 49 576 CCB exposures included in the study; 626 exposures (1.2%) had reported hyperglycemia. The relative risk of a severe medical outcome in cases with hyperglycemia compared to cases without hyperglycemia was 21.8 (95% CI, 19.6-24.4). Exposures in cases of people older than age 20 had a relative risk of hyperglycemia of 8.6 (95% CI, 6.8-10.9) and a relative risk of a severe medical outcome of 5.6 (95% CI, 4.9-6.5). In intentional exposures, the relative risk of hyperglycemia was 11.3 (95% CI, 9.6-13.3), and the relative risk of death or a severe medical outcome was 12.1 (95% CI, 10.8-13.7).

In this large retrospective review of CCB exposures, hyperglycemia was an uncommon event. When present, hyperglycemia was associated with a severe medical outcome. Intentional exposures and exposures in people older than age 20 years also were associated with increased incidence of hyperglycemia and a severe medical outcome.