Calcium (2 g every 30 min), glucagon (5 mg), and epinephrine-boluses (0.5-1 mg) were given, and a ventricular pacing lead was inserted via the internal jugular vein during continuous resuscitation. Her primary rhythm was a slow idioventricular rhythm and after few minutes she went into asystole. She was tracheally intubated and resuscitation was begun. Fifteen minutes after arrival, the patient convulsed and went pulseless. An arterial catheter was inserted and a MAP of 65/40 mm Hg was measured.

min −1 was initiated and calcium (4 g) and atropine boluses (2 mg) were given.

Her heart rate was 50 bpm in sinus rhythm and oxygen saturation was 99%. Upon arrival 30 min later, she was unconscious, her MAP was not measurable, but a carotid pulse was palpable. Because of severe overdose, the patient was directly admitted to the intensive care unit. She was given 50 g of activated charcoal solution orally and an IV infusion was initiated. Her mean arterial blood pressure (MAP) was 160/100 mm Hg and heart rate 100 bpm. Paramedics were called for a 47-yr-old female who had taken 16 g of verapamil 1 h previously.

We report two cases in which cardiovascular collapse after massive CCB overdose were successfully treated with levosimendan together with traditional treatment measures. 6,7 To our knowledge, its use in CCB overdose has not been reported. Levosimendan enhances cardiac contraction by improving the use of available cytosolic calcium, rather than by flooding the cell with excessive calcium. Levosimendan is a calcium sensitizer and its mechanism differs from other inotropes. 4,5Ī new inotropic drug, levosimendan, has pharmacological properties which, in theory, could be beneficial in treating the hemodynamic compromise of severe CCB overdose. Mechanical support of the circulation with intraaortic balloon pulsation (IABP) or extracorporeal circulation have also been reported. 3,4 Ventricular pacing is often needed because of severe bradycardia, but problems with pacing capture are common. Therapy in severe intoxication includes high doses of catecholamines, glucagon and measures to inhibit further ingestion and absorption of the drug. 2 Overdose of CCBs causes cardiovascular depression, which is often refractory to standard resuscitation methods.

1 More than one third of deaths from cardiovascular drug overdose are related to CCBs. Severe calcium channel blocker (CCB) overdose has a high mortality rate.

Glucagon as beta blocker antidote