Q: Of the following which can be used as treatment of calcium channel blockers toxicity?

A)  Intravenous calcium
B)  Atropine
C) Hyperinsulinemia-euglycemia therapy 
D) lipid emulsion therapy
E) All of the above

Answer: E

Mild toxicity of Calcium channel blockers usually resolved with supportive treatment with IVF and transient support with pressors. In case of acute overdose, activated charcoal, gastric lavage, and polyethylene glycol may be used to decontaminate the gut.

In case of severe toxicity, Intravenous calcium can be used. Atropine as well as temporary intravenous pacemaker may be required for un-resolving bradycardia/blocks.

Hyperinsulinemia-euglycemia therapy has been advocated for treatment. Increased insulin mobilizes glucose from peripheral tissues to serve as an alternative fuel source for the heart. Treatment with lipid emulsion therapy has been described too with same mechanism of action.