A patient with extended-release verapamil poisoning has HR 38/min, BP 66/34 mmHg, lactate 7 mmol/L and glucose 19 mmol/L despite fluids, atropine and

Question

A patient with extended-release verapamil poisoning has HR 38/min, BP 66/34 mmHg, lactate 7 mmol/L and glucose 19 mmol/L despite fluids, atropine and calcium. What metabolic therapy should be initiated?

Accepted Answer

Start high-dose insulin with dextrose and glucose and potassium monitoring

Answer

Give glucagon alone and defer vasopressors until serum glucose normalizes

Answer

Start digoxin to improve inotropy while maintaining the verapamil concentration

Answer

Give sodium bicarbonate until QRS is below 100 ms despite a narrow baseline QRS

Answer

Start a conventional diabetic insulin infusion targeting glucose below 6 mmol/L

Calcium channel blocker overdose — RCPSC EM MCQ

A patient with extended-release verapamil poisoning has HR 38/min, BP 66/34 mmHg, lactate 7 mmol/L and glucose 19 mmol/L despite fluids, atropine and calcium. What metabolic therapy should be initiated?