Calcium therapy
Administration of calcium can partially reverse the effects of verapamil or diltiazem poisoning. If hypotension and bradycardia persist after initial resuscitation with intravenous fluids, give calcium therapy. Aim for a serum ionised calcium concentration of 1.5 to 2.0 mmol/L. Calcium gluconate is preferred to calcium chloride as it causes less local irritation.
For adults, use:
1 calcium gluconate 0.22 mmol/mL1 6.6 mmol (30 mL) intravenously, over 2 to 3 minutes, via a large peripheral vein, with ECG monitoring. Repeat the dose once after 10 minutes if required CCB verapamil and diltiazem poisoning
OR
1 calcium chloride 0.68 mmol/mL (10%) 6.8 mmol (10 mL) intravenously, over 2 to 3 minutes, via a large peripheral vein, with ECG monitoring. Repeat the dose once after 10 minutes if required. CCB verapamil and diltiazem poisoning
For children, use:
1 calcium gluconate 0.22 mmol/mL1 0.13 mmol/kg up to 6.6 mmol (0.6 mL/kg up to 30 mL) intravenously, over 2 to 3 minutes, via a large peripheral vein, with ECG monitoring. Repeat the dose once after 10 minutes if required CCB verapamil and diltiazem poisoning
OR
1 calcium chloride 0.68 mmol/mL (10%) 0.14 mmol/kg up to 6.8 mmol (0.2 mL/kg up to 10 mL) intravenously, over 2 to 3 minutes, via a large peripheral vein, with ECG monitoring. Repeat the dose once after 10 minutes if required. CCB verapamil and diltiazem poisoning
For all patients, then start a calcium infusion to maintain the serum ionised calcium concentration between 1.5 to 2.0 mmol/L.
For adults, use:
1calcium gluconate 0.22 mmol/mL1 0.66 to 6.6 mmol/hour (3 to 30 mL/hour) by intravenous infusion via a large peripheral vein
OR
1calcium chloride 0.68 mmol/mL (10%) 0.68 to 6.8 mmol/hour (1 to 10 mL/hour) by intravenous infusion via a central venous catheter.
For children, use:
1calcium gluconate 0.22 mmol/mL1 0.01 to 0.13 mmol/kg/hour (0.06 to 0.6 mL/kg/hour) by intravenous infusion via a large peripheral vein
OR
1 calcium chloride 0.68 mmol/mL (10%) 0.01 to 0.14 mmol/kg/hour (0.02 to 0.2 mL/kg/hour) by intravenous infusion via a central venous catheter.
Measure the serum ionised calcium concentration every 2 to 4 hours to ensure it remains in the desired range.