Treatment for hypotension

Commence continuous ECG monitoring and assess serial 12-lead ECGs in all patients with verapamil or diltiazem poisoning.

If the patient is hypotensive after verapamil or diltiazem poisoning, first-line treatment is intravenous fluid resuscitation. If hypotension persists, give calcium therapy and start inotropic support with adrenaline (epinephrine).

Following verapamil or diltiazem poisoning, it is important to target the cause of hypotension. Usually hypotension is caused by a combination of bradycardia, myocardial depression and vasoplegia. Bedside echocardiography is useful to determine the relative contributions of vasodilation and negative inotropy to hypotension, and hence guides treatment choice—discuss with a clinical toxicologist.