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Calcium channel blocker overdose — RCPSC EM MCQ

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HardCardiovascular emergenciesCalcium channel blocker overdoseRCPSC EM

A 59-year-old man overdoses on diltiazem extended-release. BP is 72/38, HR is 42, glucose is 11 mmol/L, calcium is normal, and ECG shows junctional bradycardia. He remains hypotensive after fluids and calcium. What is the most appropriate initial management?

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Correct answer: C — Start high-dose insulin euglycaemic therapy with vasopressors

Severe calcium-channel blocker toxicity with bradycardic shock requires calcium, vasopressors and high-dose insulin euglycaemic therapy with poison-centre input.

Reference: Poison centre toxicology guidance; Goldfrank-style ED toxicology principles