Chapter 81 Poisoning by Cardiovascular Drugs
6 What vasopressor(s) should be used in patients with hypotension poisoned by β-blockers or calcium channel blockers?
10 What else can be done for the patient with cardiovascular collapse in whom other medical therapies are failing?
Key Points Poisoning by Cardiovascular Drugs
1. Distinguishing among digoxin, β-blocker, and calcium channel blocker toxicity may be difficult, but digoxin toxicity is often associated with other systemic symptoms, such as nausea, weakness, and visual changes.
2. If digitalis toxicity is suspected, prompt administration of digoxin immune Fab is indicated.
3. Glucagon remains a first-line treatment for β-blocker toxicity.
4. The treatments of choice for calcium channel blocker toxicity include high-dose, direct-acting vasopressors and hyperinsulinemia-euglycemia therapy.
5. ILE has shown benefit in treatment of poisonings for several types of cardiotoxic drugs and should be considered for any poisoned patient who has ingested a highly lipid-soluble drug with significant hemodynamic instability.
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7 Patel N.P., Pugh M.E., Goldberg S., et al. Hyperinsulinemic euglycemia therapy for verapamil poisoning: a review. Am J Crit Care. 2007;16:498–503.
8 Rothschild L., Bern S., Oswald S., et al. Intravenous lipid emulsion in clinical toxicology. Scand J Trauma Resusc Emerg Med. 2010;5:51.
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