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Calcium Channel Blocker Overdose — RACP Adult Medicine MCQ

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HardClinical PharmacologyCalcium Channel Blocker OverdoseRACP Adult Medicine

A 28-year-old has profound bradycardic shock after sustained-release verapamil despite airway support, IV calcium and atropine. What metabolic-inotropic therapy should be started with frequent glucose and potassium monitoring?

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Correct answer: DHigh-dose insulin with dextrose titrated to haemodynamic response

The best answer is “High-dose insulin with dextrose titrated to haemodynamic response”. High-dose insulin-euglycaemia therapy improves myocardial carbohydrate use and contractility in severe calcium-channel-blocker poisoning. Dextrose and potassium are monitored and replaced while vasopressors and other rescue measures are added according to physiology. Lipid emulsion is a selected rescue option, glucagon is more often considered in beta-blocker toxicity, and bicarbonate targets sodium-channel blockade rather than isolated verapamil shock.

Reference: NSW Agency for Clinical Innovation: Toxicology resources: https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-resources/toxicology