08/11/2025
⚠️ Case Spotlight: The Silent Threat of CCB Overdose
10 hours ago, a 32-year-old woman deliberately ingested 30 Diltiazem tablets. She presented to our ED with profound hypotension. I’m still managing her, and despite fluids, noradrenaline infusion, and high-dose insulin euglycaemic therapy (HIET), her blood pressure remains critically low.
🚨 Calcium Channel Blocker (CCB) Poisoning – A Silent Killer in the ED!
💊 Common culprits: Amlodipine, Verapamil, Diltiazem, Nifedipine
Even a few extra tablets can cause life-threatening hypotension, bradycardia, and cardiac arrest.
Unlike β-blocker toxicity, CCB overdose causes profound shock with normal or high blood glucose due to insulin resistance!
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⚡ Clinical Picture
• Bradycardia & hypotension → leading to cardiogenic shock
• Altered mental state, dizziness, syncope
• Hyperglycaemia, metabolic acidosis, lactic acidosis
• Pulmonary oedema (esp. with non-dihydropyridines like verapamil)
💉 Stepwise Management
1️⃣ Initial Support
• ABCs, oxygen, IV access, cardiac monitoring
• Activated charcoal (if
