Case Report
Volume 8 Issue 4 - 2020
A Case Series of Calcium Channel Blocker Poisoning - Pivotal Role of Hyperinsulinemia-Euglycemia Therapy
Lakshmikanthcharan S1*, Vivekananthan P1, Sivakumar MN2 and Eldho Mathew3
1Consultant Intensivist, Department of Critical Care, Royalcare Superspeciality Hospital, Coimbatore, India
2Head, Department of Critical Care, Royalcare Superspeciality Hospital, Coimbatore, India
3Clinical Pharmacist, Bareen International Hospital, MBZ City, Abu Dhabi, UAE
*Corresponding Author: Lakshmikanthcharan S, Consultant Intensivist, Department of Critical Care, Royalcare Superspeciality Hospital, Coimbatore, India.
Received: March 02, 2020; Published: March 19, 2020


Introduction: Calcium Channel Blockers (CCBs) are commonly used in the management of hypertension. Hyperinsulinemia-Euglycemia Therapy (HET) is a vital intervention in the management of CCB poisoning. We share our experience in three cases of CCB over dosages, who survived with HET.

Objective: To emphasize the effectiveness of Hyperinsulinemia-Euglycemia Therapy along with other conventional measures in the early recovery from Calcium Channel Blocker poisoning induced refractory shock.

Case Presentation: We hereby report three cases of CCB over-dosage with consumption of 75 - 100 mg of amlodipine tablets. They presented with refractory hypotension and tachycardia. Initial management was with decontamination, fluid resuscitation, inotropes, glucagon and calcium gluconate. Later we introduced Hyperinsulinemia-Euglycemia Therapy. Patient’s hemodynamics gradually became stable and were weaned off inotropic supports.

Discussion: HET is a potentially life-saving treatment in calcium channel blocker toxicity. We suggest that such therapy should be considered early in patients those who are not responding to conventional treatment.

Conclusion: We conclude that amlodipine (CCB) overdose can be effectively treated with early GI decontamination, fluid resuscitation, calcium and glucagon infusions, and cautious use of inotropes with careful monitoring of possible complications. The use of Hyperinsulinemia-Euglycemia therapy is required in the treatment of Calcium Channel Blocker overdose in non-responders.

Keywords: Amlodipine Overdose; Calcium Channel Blocker; Glucagon; Hyperinsulinemia; Euglycemia Therapy


  1. Christensen MB., et al. “Outcomes following calcium channel blocker exposures reported to a poison information center”. BMC Pharmacology and Toxicology 19 (2018): 78.
  2. M Spedding and R Paoletti. “Classification of calcium channels and the sites of action of drugs modifying channel function”. Pharmacological Reviews 44.3 (1992): 363-876.
  3. DR Abernethy and JB Schwartz. “Calcium-antagonist drugs”. The New England Journal of Medicine 341.19 (1999): 1447-1457.
  4. KL Cumpston., et al. “Whole bowel irrigation and the hemodynamically unstable calcium channel blocker overdose: primum non nocere”. Journal of Emergency Medicine 38.2 (2010): 171-174.
  5. SD Salhanick and MW Shannon. “Management of calcium channel antagonist overdose”. Drug Safety 26.2 (2003): 65-79.
  6. Cumpston K., et al. “Failure of hyperinsulinemia/euglycaemia therapy in severe diltiazem overdose”. Journal of Toxicology: Clinical Toxicology 40 (2002): 618.
  7. Megarbane B., et al. “The role of insulin and glucose(hyper-insulinaemia/euglycemia) therapy in acute calcium channel antagonist and beta-blocker poisoning”. Toxicological Reviews 23.4 (2004): 215-222.
  8. Kline JA., et al. “The diabetogenic effects of acute verapamil poisoning”. Toxicology and Applied Pharmacology 145.2 (1997): 357-362.
  9. Ohtam Nelson J., et al. “Effect of Ca++ channel blocker on energy level and stimulated insulin secretion in isolated rat islets of Langerhans”. Journal of Pharmacology and Experimental Therapeutics 264.1 (1993): 35-40.
  10. Maude St-Onge., et al. “Experts Consensus Recommendations for the Management of Calcium Channel Blocker Poisoning in Adults”. Critical Care Medicine 45.3 (2017).
  11. Humbert VH Jr., et al. “Noncardiogenic pulmonary edema complicating massive Diltiazem overdose”. Chest 99 (1991): 258-259.
  12. Saravu K and Balasubramanian R. “Near-Fatal Amlodipine poisoning”. Journal of the Association of Physicians of India 52 (2004): 156-157.
  13. Lam YM., et al. “Continuous calcium chloride infusion for massive nifedipine overdose”. Chest 119 (2001): 1280-1282.
Citation: Lakshmikanthcharan S., et al. ““A Case Series of Calcium Channel Blocker Poisoning - Pivotal Role of Hyperinsulinemia-Euglycemia Therapy”. EC Pharmacology and Toxicology 8.4 (2020): 17-21.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

March Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the March issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for April Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the May issue of respective journals. Submissions are accepted on/before April 14, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to