The Poison Review

Pediatr Emerg Care 2009;25:532-541

This review of calcium channel blocker (CCB) toxicity is intended as continuing medical education for emergency medicine physicians and residents.  While the authors provide a good brief discussion of pharmacologic mechanisms and the presentation of CCB overdose, they end up being more confusing than helpful when it comes to treatment.  As is too often the case in many review articles and textbook chapters, their article mentions — uncritically — a number of interventions that have no proven benefit, are unlikely to be beneficial, and may actually be harmful.  For example, does the clinician really want to consider multidose charcoal and whole bowel irrigation (WBI) in a severely toxic CCB overdose patient who may quickly become unstable and hypotensive. (If the patient isn’t severely intoxicated, gastrointestinal decontamination will not be beneficial in any case.) Does one really want to send this patient to the CT scanner to try to visualize a CCB bezoar?  In my opinion, articles such as this (and text chapters) should emphasize good supportive care, proven antidotes, and established interventions.  Certainly potentially risky interventions that have only appeared in case reports should be critically evaluated if they are mentioned at all.