{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T15:33:22Z","timestamp":1767972802324,"version":"3.49.0"},"reference-count":18,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,6,22]],"date-time":"2017-06-22T00:00:00Z","timestamp":1498089600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Basic Clin Pharma Tox"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>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\u2010quality evidence from the heterogeneous literature. We describe a case of a severe diltiazem intoxication and critically appraise the efficacy and role of high\u2010dose calcium and glucagon infusions. A 53\u2010year\u2010old woman was admitted to the emergency department with a cardiogenic shock with complete<jats:styled-content style=\"fixed-case\">AV<\/jats:styled-content>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\u2010dose 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\u2010directed 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.<\/jats:p>","DOI":"10.1111\/bcpt.12809","type":"journal-article","created":{"date-parts":[[2017,5,15]],"date-time":"2017-05-15T07:32:52Z","timestamp":1494833572000},"page":"447-449","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A Critical Note on Treatment of a Severe Diltiazem Intoxication: High\u2010Dose Calcium and Glucagon Infusions"],"prefix":"10.1111","volume":"121","author":[{"given":"Mathilde","family":"Van Veggel","sequence":"first","affiliation":[{"name":"Department of Pharmacy Franciscus Gasthuis Hospital Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gijs","family":"Van der Veen","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine Franciscus Gasthuis Hospital Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Jansen","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine Franciscus Gasthuis Hospital Rotterdam The Netherlands"},{"name":"Department of Intensive Care Medicine HagaZiekenhuis Den Haag The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elsbeth","family":"Westerman","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Franciscus Gasthuis Hospital Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,6,22]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-200326020-00001"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/18.suppl_A.56"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.2165\/00139709-200423040-00003"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.3109\/15563650.2015.1102927"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.3109\/15563650.2014.965827"},{"key":"e_1_2_5_7_1","first-page":"60","article-title":"Practical recommendations for calcium channel antagonist poisoning","volume":"74","author":"Rietjens SJ","year":"2016","journal-title":"Neth J Med"},{"key":"e_1_2_5_8_1","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/S0022-3565(25)10276-0","article-title":"Effect of Ca++ channel blockers on energy level and stimulated insulin secretion in isolated rat islets of Langerhans","volume":"264","author":"Ohta M","year":"1993","journal-title":"J Pharmacol Exp Ther"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbabio.2009.01.005"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(95)90290-2"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12763"},{"key":"e_1_2_5_12_1","unstructured":"Zane HorowitzB LungD.Calcium Channel Blocker Toxicity: Medscape;2015.http:\/\/emedicine.medscape.com\/article\/2184611-overview(last accessed on 30 May 2017)."},{"key":"e_1_2_5_13_1","unstructured":"Diltiazem monograph: Toxbase;2014.https:\/\/www.toxbase.org\/(last accessed on 17 March 2016)."},{"key":"e_1_2_5_14_1","unstructured":"GroulsRJEB BindelsAJGH RoosAN.Toxicologie behandelinformatie: Calciumantagonisten: Dutch Association of Hospital Pharmacists;2015.http:\/\/toxicologie.org\/monografie\/calciumantagonisten(last accessed on 1 June 2016)."},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650601072233"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03160947"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197808000-00012"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/193229681000400606"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/096032718900800611"}],"container-title":["Basic &amp; 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