LAUSR

Calcium channel blockers (CCBs) are widely prescribed for different cardiovascular disorders, e.g., hypertension, coronary artery disease and cardiac arrhythmias. The primary mechanism of action of CCBs is inhibiting calcium influx by antagonism of the L-type voltage-gated calcium channels in vascular smooth muscle cells and cardiomyocytes. In overdose, CCBs can cause serious complications, such as severe hypotension, bradycardia and a diversity of conduction disturbances. Within the group of cardiovascular drugs, CCBs are the leading class of drugs associated with the largest number of poisoning fatalities. Treatment of CCB overdose should first be aimed at aggressive gastrointestinal decontamination, particularly in case of patients with large recent ingestions, and supportive care, i.e., the administration of intravenous fluids, and correction of metabolic acidosis and electrolytes. Patients with severe CCB poisoning may need a well-tailored combination of interventions, e.g., the administration of calcium, high-dose insulin (HDI) and vasopressors. In patients refractory to these treatments, intravenous lipid emulsion or extracorporeal life support should always be considered as last resort therapy. 2 | PROPOSED MECHANISM OF ACTION OF HDI