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Calcium-channel blocker overdose — SCE Acute Medicine MCQ

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HardToxicology and OverdoseCalcium-channel blocker overdoseSCE Acute Medicine

A 62-year-old woman is assessed on the acute medical unit. She took modified-release verapamil and is hypotensive with bradycardia. Glucose is 14 mmol/L and lactate is rising despite fluids. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: C — Give intravenous calcium and high-dose insulin therapy

Give intravenous calcium and high-dose insulin therapy is the best answer because severe calcium-channel blocker overdose causes vasoplegia and myocardial depression requiring calcium plus high-dose insulin strategy. Arrange urgent CT imaging before treatment is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Hyperglycaemia can be a marker of severe calcium-channel blocker toxicity.

Reference: Toxbase; BNF