MANAGEMENT OF SERIOUS CALCIUM CHANNEL BLOCKER OVERDOSE IN ADULTS

Normal saline bolus (10–20 mL/kg)
Correct pH
10% calcium chloride, 5–10 mL, or 10% calcium gluconate, 10–20 mL, over 5 minutes

Repeat every 3–5 minutes, up to three to five doses
If response, institute calcium infusion (10% calcium chloride, 1–10 mL/hour)
Monitor serum calcium after 30 mL of calcium chloride or equivalent

Glucagon, 0.075–0.15 mg/kg i.v. (use water for injection as diluent)Repeat every 5–10 minutes as needed

If response, consider infusion of 0.075–0.15 mg/kg/hour

Atropine, isoprenaline (isoproterenol) and/or pacing may be tried if associated symptomatic bradycardia
Dopamine infusion if persistent hypotension

If no response to the above, begin insulin euglycaemia therapy

Insulin bolus, 1 unit/kg with glucose, 50% dextrose, 25 ml i.v.
followed by
Insulin infusion, 0.5 units/kg/hour with 50% dextrose infusion, 0.5 g/hour, adjusted according to hourly glucose checks

As a last resort, extracorporeal blood pressure support (e.g. cardiopulmonary bypass) may be considered

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