Pediatric Calcium Channel Blocker Toxicity Differential Diagnoses

  • Author: Derrick Lung, MD, MPH; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Dec 9, 2011
 
 

Diagnostic Considerations

Conditions to consider in the differential diagnosis of calcium channel blocker toxicity include the following:

  • Ingestion of any alcohols or cyclic esters
  • Clonidine ingestion
  • Ingestion of any plants containing digoxinlike compounds (eg, grayanotoxin, oleander, foxglove)
  • Narcotic toxicity
  • Septicemia
  • Septic shock
  • Spinal shock
  • Typhoid
  • Allergic reaction
  • Trauma resulting in tamponade and tension pneumothorax
  • Respiratory arrest (infants)
  • Bacterial pericarditis
  • Viral pericarditis
  • Ingestion of any sedative hypnotics, including benzodiazepines, barbiturates, and nonbarbiturate sedative hypnotics (eg, glutethimide)
  • Beta-blocker ingestion

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Derrick Lung, MD, MPH  Fellow, Medical Toxicology, University of California, San Francisco, School of Medicine; Clinical Instructor, Division of Emergency Medicine, Stanford University Medical Center

Derrick Lung, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, MMB, FACEP  Assistant Professor, Associate Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate Medical Center

Mark A Silverberg, MD, MMB, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose .

References

  1. Adams BD, Browne WT. Amlodipine overdose causes prolonged calcium channel blocker toxicity. Am J Emerg Med. Sep 1998;16(5):527-8. [Medline].

  2. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Phila). Dec 2010;48(10):979-1178. [Medline].

  3. Koren G. Medications which can kill a toddler with one tablet or teaspoonful. J Toxicol Clin Toxicol. 1993;31(3):407-13. [Medline].

  4. Belson MG, Gorman SE, Sullivan K, Geller RJ. Calcium channel blocker ingestions in children. Am J Emerg Med. Sep 2000;18(5):581-6. [Medline].

  5. Levine M, Boyer EW, Pozner CN, Geib AJ, Thomsen T, Mick N, et al. Assessment of hyperglycemia after calcium channel blocker overdoses involving diltiazem or verapamil. Crit Care Med. Sep 2007;35(9):2071-5. [Medline].

  6. Olson KR, Erdman AR, Woolf AD, et al. Calcium channel blocker ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(7):797-822. [Medline].

  7. Laine K, Kivistö KT, Neuvonen PJ. Effect of delayed administration of activated charcoal on the absorption of conventional and slow-release verapamil. J Toxicol Clin Toxicol. 1997;35(3):263-8. [Medline].

  8. Chin L, Picchioni AL, Bourn WM, Laird HE. Optimal antidotal dose of activated charcoal. Toxicol Appl Pharmacol. Sep 1973;26(1):103-8. [Medline].

  9. Engebretsen KM, Kaczmarek KM, Morgan J, Holger JS. High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning. Clin Toxicol (Phila). Apr 2011;49(4):277-83. [Medline].

  10. Bania TC, Chu J, Perez E, Su M, Hahn IH. Hemodynamic effects of intravenous fat emulsion in an animal model of severe verapamil toxicity resuscitated with atropine, calcium, and saline. Acad Emerg Med. Feb 2007;14(2):105-11. [Medline].

  11. Tebbutt S, Harvey M, Nicholson T, Cave G. Intralipid prolongs survival in a rat model of verapamil toxicity. Acad Emerg Med. Feb 2006;13(2):134-9. [Medline].

  12. Young AC, Velez LI, Kleinschmidt KC. Intravenous fat emulsion therapy for intentional sustained-release verapamil overdose. Resuscitation. May 2009;80(5):591-3. [Medline].

  13. Franxman TJ, Al-Nabhan M, Cavallazzi RS, Speak AJ. Lipid emulsion therapy for verapamil overdose. Ann Intern Med. Feb 15 2011;154(4):292. [Medline].

  14. French D, Armenian P, Ruan W, Wong A, Drasner K, Olson KR, et al. Serum verapamil concentrations before and after Intralipid® therapy during treatment of an overdose. Clin Toxicol (Phila). Apr 2011;49(4):340-4. [Medline].

  15. French D, Smollin C, Ruan W, Wong A, Drasner K, Wu AH. Partition constant and volume of distribution as predictors of clinical efficacy of lipid rescue for toxicological emergencies. Clin Toxicol (Phila). Nov 2011;49(9):801-9. [Medline].

  16. American College of Medical Toxicology. ACMT position statement: interim guidance for the use of lipid resuscitation therapy. J Med Toxicol. Mar 2011;7(1):81-2. [Medline].

  17. Varpula T, Rapola J, Sallisalmi M, Kurola J. Treatment of serious calcium channel blocker overdose with levosimendan, a calcium sensitizer. Anesth Analg. Mar 2009;108(3):790-2. [Medline].

  18. Durward A, Guerguerian AM, Lefebvre M, Shemie SD. Massive diltiazem overdose treated with extracorporeal membrane oxygenation. Pediatr Crit Care Med. Jul 2003;4(3):372-6. [Medline].

 
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