Thanks for the comments. The older I get, the more I’m convinced that the keys to successful outcomes in significant overdose cases are meticulous supportive care, enhanced elimination (e.g. hemodialysis) when indicated, and appropriate antidotes when available. The rest is piffle. I predict that in the next five to ten years, gastric lavage and whole bowel irrigation will have gone the way of ipecac-induced emesis, and both patients and medical staff will be the better for it.

In a review of several hundred cases of WBI, we never documented any cases of intact pellets (baggies of drugs yes, but not medications from overdose).

The urge to ‘do something’ in patients with potentially lethal ingestions such as a large calcium channel blocker ingestions is great, but it must tempered with ‘lets do the right thing’. What the right thing is unfortunately takes a lot of time (years) and a lot of patient encounters over those many years.

Nice synopsis Dr. Gussow

Thanks so much for the encouraging words. I’m glad you enjoyed the discussion of CCBs on EMCrit, and hope you continue to find TPR useful and informative.