Skip to main content

Prognostic factors of acute calcium-channel blocker poisonings

Introduction

The incidence of acute calcium-channel blocker (CCB) poisonings is increasing. Our objectives were to describe the CCB-poisoned patients admitted to the ICU and to determine the prognostic factors.

Methods

Retrospective collection of clinical data in three ICU in 2000–2006; determination of plasma concentration using HPLC (REMEDI). Description (median, (25–75% percentiles)); comparisons using Mann–Whitney and chi-squared tests; multivariate analysis using a step-by-step logistic regression model.

Results

Eighty-four patients (47 males/36 females, 44 years (31–56); SAPS II, 15 (8–25)) were included. Verapamil (39/83), diltiazem (13/83), nifedipine (11/83), nicardipin (9/83), and amlopdipine (8/83) were involved. On admission, systolic blood pressure was 105 mmHg (86–118), heart rate 76/min (67–91), QRS duration 85 ms (80–110), and plasma lactate concentration 2.86 mmol/l (1.79–5.98). Poisoning features included shock (42/83), atrioventricular block (34/83), asystole (8/83), and/or ventricular arrhythmia (4/83). All patients received fluid replacement, 50/83 epinephrine infusion (maximal rate: 3.0 mg/hour (1.4–8.0)), and 27/83 norepinephrine (5.0 mg/hour (2.9–15.0)). Thirty-three out of 83 were mechanically ventilated. Treatments included calcium salts (22/83), glucagon (18/83), dobutamine (18./33), 8.4% sodium bicarbonate (16/83), isoprenaline (14/83), insulin + glucose (13/83), terlipressin (4/83), electrosystolic stimulation (2/83), and extracorporeal life support (5/83). Eleven patients (13%) died in the ICU. The plasma verapamil concentration was significantly different on admission regarding survival (800 versus 2,522 mg/l, P < 0.05). If excluding SAPS II from the model, multivariate analysis showed that QRS duration (>100 ms; OR, 5.3; 95% CI, 1.1–27.0) and maximal epinephrine rate (>5 mg/hour; OR, 27.6; 9%% CI, 5.3–144.7) were the only two predictive factors of death (P = 0.007). Shock was refractory if epinephrine + norepinephrine was ≥ 8 mg/hour with renal (creatinine > 150 μmol/l) or respiratory failure (PaO2/FiO2 > 150 mmHg) (sensitivity, 100%; specificity, 89%).

Conclusion

Despite optimal management in the ICU, the CCB poisoning mortality remains high (13%), encouraging development of extracorporeal life support and new antidotes.

Author information

Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Karyo, S., Mégarbane, B., Abidi, K. et al. Prognostic factors of acute calcium-channel blocker poisonings. Crit Care 12, P360 (2008). https://doi.org/10.1186/cc6581

Download citation

Keywords

  • Verapamil
  • Nifedipine
  • Diltiazem
  • Dobutamine
  • Nicardipin