skip to main content

Diltiazem overdose — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateToxicology and OverdoseDiltiazem overdoseSCE Acute Medicine

A 45-year-old man presents with collapse, confusion or vomiting after a possible exposure. Relevant history includes medication, recreational or environmental exposure. On assessment, toxidrome features and physiological instability are present. Investigations show modified-release diltiazem ingestion with shock, AV block and hyperglycaemia. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Give intravenous calcium and start high-dose insulin euglycaemic therapy

The key discriminator is that modified-release diltiazem ingestion with shock, AV block and hyperglycaemia, which makes Give intravenous calcium and start high-dose insulin euglycaemic therapy the single best answer. Arrange routine outpatient follow-up is less appropriate because it does not address the dominant acute risk in the vignette; Start anticoagulation after assessing bleeding risk would fit a different presentation or later stage of care. Start broad-spectrum intravenous antibiotics and Give controlled oxygen and senior review are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: TOXBASE; BNF