The morbidity and mortality of a severe
calcium channel blocker intoxication is high due to serious toxic cardiac effects. Its treatment is supported by low-quality evidence from the heterogeneous literature. We describe a case of a severe
diltiazem intoxication and critically appraise the efficacy and role of high-dose
calcium and
glucagon infusions. A 53-year-old woman was admitted to the emergency department with a
cardiogenic shock with complete
AV block, not responding to
atropine,
isoprenaline and an external pacemaker. Later on, it became clear that she had a severe
diltiazem intoxication which was successfully treated with isotone fluids, inotropes, vasopressors and continuous infusion of high-dose
calcium and
glucagon. The patient developed, however, an
acute, necrotizing pancreatitis, probably related to iatrogenic high
calcium levels. This case demonstrates lack of consensus regarding target levels of serum
calcium for treatment of a severe
diltiazem intoxication. Goal-directed tapering of
calcium should prevent side effects of iatrogenic hypercalcaemia. The contribution of
glucagon infusions is doubtful due to the instability of solubilized
glucagon. This might explain why the effect of
glucagon is variable in the literature.