{"title":"钙通道阻滞剂中毒流行病学的发展及其对管理的影响。","authors":"Michael D Simpson, Jon B Cole","doi":"10.1097/MCC.0000000000001218","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this study was to outline recent developments in calcium channel blocker (CCB) poisoning. The dihydropyridine CCB amlodipine is commonly prescribed in the United States, and amlodipine poisoning is increasing in frequency, presenting new challenges for clinicians because current paradigms of CCB poisoning management arose from literature on non-dihydropyridine agents.</p><p><strong>Recent findings: </strong>Amlodipine is now the most common CCB involved in poisoning. High-dose insulin is a potent inotrope and vasodilator; as such, it should be used cautiously, and typically in conjunction with vasopressors, as it theoretically may worsen vasodilation in amlodipine poisoning. High-dose insulin is best used when some degree of cardiogenic shock is suspected. Venoarterial extracorporeal membrane oxygenation utilization in CCB poisoning appears to be increasing, but high flow rates may be needed to combat amlodipine-induced vasoplegia. Intravenous lipid emulsion cannot be routinely recommended but may have a role in peri-arrest situations. Adjunct treatments such as angiotensin II, methylene blue, and hydroxocobalamin offer theoretical benefit but warrant further study.</p><p><strong>Summary: </strong>Amlodipine causes most cases of CCB poisoning and can induce both cardiogenic and distributive shock through multiple mechanisms. Clinicians should tailor treatment to suspected shock etiology, be aware of adjunct treatments for refractory shock, and consult an expert in poisoning.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":null,"pages":null},"PeriodicalIF":3.5000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Developments in the epidemiology of calcium channel blocker poisoning and implications for management.\",\"authors\":\"Michael D Simpson, Jon B Cole\",\"doi\":\"10.1097/MCC.0000000000001218\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose of review: </strong>The aim of this study was to outline recent developments in calcium channel blocker (CCB) poisoning. The dihydropyridine CCB amlodipine is commonly prescribed in the United States, and amlodipine poisoning is increasing in frequency, presenting new challenges for clinicians because current paradigms of CCB poisoning management arose from literature on non-dihydropyridine agents.</p><p><strong>Recent findings: </strong>Amlodipine is now the most common CCB involved in poisoning. High-dose insulin is a potent inotrope and vasodilator; as such, it should be used cautiously, and typically in conjunction with vasopressors, as it theoretically may worsen vasodilation in amlodipine poisoning. High-dose insulin is best used when some degree of cardiogenic shock is suspected. Venoarterial extracorporeal membrane oxygenation utilization in CCB poisoning appears to be increasing, but high flow rates may be needed to combat amlodipine-induced vasoplegia. Intravenous lipid emulsion cannot be routinely recommended but may have a role in peri-arrest situations. Adjunct treatments such as angiotensin II, methylene blue, and hydroxocobalamin offer theoretical benefit but warrant further study.</p><p><strong>Summary: </strong>Amlodipine causes most cases of CCB poisoning and can induce both cardiogenic and distributive shock through multiple mechanisms. Clinicians should tailor treatment to suspected shock etiology, be aware of adjunct treatments for refractory shock, and consult an expert in poisoning.</p>\",\"PeriodicalId\":10851,\"journal\":{\"name\":\"Current Opinion in Critical Care\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Current Opinion in Critical Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/MCC.0000000000001218\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/25 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Opinion in Critical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MCC.0000000000001218","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/25 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Developments in the epidemiology of calcium channel blocker poisoning and implications for management.
Purpose of review: The aim of this study was to outline recent developments in calcium channel blocker (CCB) poisoning. The dihydropyridine CCB amlodipine is commonly prescribed in the United States, and amlodipine poisoning is increasing in frequency, presenting new challenges for clinicians because current paradigms of CCB poisoning management arose from literature on non-dihydropyridine agents.
Recent findings: Amlodipine is now the most common CCB involved in poisoning. High-dose insulin is a potent inotrope and vasodilator; as such, it should be used cautiously, and typically in conjunction with vasopressors, as it theoretically may worsen vasodilation in amlodipine poisoning. High-dose insulin is best used when some degree of cardiogenic shock is suspected. Venoarterial extracorporeal membrane oxygenation utilization in CCB poisoning appears to be increasing, but high flow rates may be needed to combat amlodipine-induced vasoplegia. Intravenous lipid emulsion cannot be routinely recommended but may have a role in peri-arrest situations. Adjunct treatments such as angiotensin II, methylene blue, and hydroxocobalamin offer theoretical benefit but warrant further study.
Summary: Amlodipine causes most cases of CCB poisoning and can induce both cardiogenic and distributive shock through multiple mechanisms. Clinicians should tailor treatment to suspected shock etiology, be aware of adjunct treatments for refractory shock, and consult an expert in poisoning.
期刊介绍:
Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.