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Atropine may be tried if hemodynamically significant bradycardia occurs; however, infranodal heart block is usually resistant to atropine in CCB toxicity.
Empiric use of glucagon (adults: 5-15 mg IV) may be warranted for patients with an unknown overdose who present with bradycardia or hypotension.
Treat hypotension with fluid boluses of normal saline if no evidence of decompensated congestive heart (CHF) exists. Administer IV calcium gluconate (up to 4 g) or IV calcium chloride (1 g) and/or glucagon (5-10 mg) if hypotension persists.
If the patient deteriorates to cardiac arrest from a CCB overdose, perform prolonged cardiopulmonary resuscitation (CPR) in the field. Patients with CCB overdose have survived neurologically intact after 1 hour of CPR.
Avoid ipecac syrup. Administer activated charcoal (AC) if the patient's airway is protected. Activated charcoal has been demonstrated to significantly absorb immediate-release medications within 1 hour of ingestion and extended-release medications as long as 4 hours after ingestion. If the ingested dose is known, a 10:1 charcoal-to-drug weight ratio can be used to calculate the optimal dose of activated charcoal to completely bind the ingested drug. Otherwise, a 1-g/kg initial dose is recommended.
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