Calcium Channel Blocker Intoxication: A Critical Care Transport Perspective

Abstract

Calcium channel blockers (CCBs) have seen an increase in rate of non-therapeutic exposure that is both accidental and intentional in nature. Patients experiencing the toxic effects of a CCB overdose are resource intensive and can quickly outstrip the capabilities of local health systems, necessitating transfer to larger tertiary or quaternary care centers. We present a case of intentional non-dihydropyridine CCB overdose and toxicity in a 20-year-old patient requiring initial stabilization at a referring critical access emergency department with continuation of treatment and support during a 60-minute rotor wing transport from the referring hospital to an academic quaternary care center. Emphasis is placed on the unique challenges in resuscitation and ongoing critical care administration during the transport phase of care. Proper stabilization of patients, planning, and consideration of potential problems associated with transport can help minimize stresses and risk of the transport, improving the outcome of extremely ill patients even under challenging circumstances.

Vasoplegic shock due to amlodipine and losartan poisoning

“…El fármaco más reportado en estas intoxicaciones fue el amlodipino, ya sea solo o combinados con otros fármacos como el diltiazem, la levotiroxina y los ARAII. Nuestra paciente consumió altas (5,6,13) dosis de losartán y amlodipino por lo que se asemeja a los demás casos publicados . Como la paciente también se intoxicó con losartán (un ARA de vida media de 12 horas), entonces el sinergismo de ambos tóxicos se complementaba con la hipoxia tisular por hipoperfusión activando así (10) las otras vías de vasodilatación .…”