Key result
IV calcium chloride reverses refractory shock and complete heart block from verapamil-metoprolol toxicity.
Why the study?
The clinical management of refractory cardiogenic shock and complete heart block induced by combined sustained-release verapamil and metoprolol treatment is not well characterized.
Case Report (n=1)
Answers are grounded in this paper and cite their sources.
May warrant calcium chloride consideration in refractory verapamil-metoprolol shock; leaves open prospective validation before practice change.
A seventy-eight-year-old woman presented with complete heart block and refractory hypotension two days after a therapeutic dose of sustained-release verapamil with concomitant use of metoprolol. The patient continued to remain hypotensive with complete heart block, even with multiple uses of intravenous atropine as well as high doses of pressor agents such as dopamine and dobutamine. However, shortly after the use of intravenous calcium chloride, the refractory hypotension and complete heart block resolved.
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Lee et al. (1995) conducted a case report in Refractory cardiogenic shock and complete heart block (n=1). Intravenous calcium chloride was evaluated on Resolution of refractory hypotension and complete heart block. Intravenous calcium chloride rapidly resolved refractory hypotension and complete heart block that were unresponsive to atropine and high-dose pressor agents in a patient treated with verapamil and metoprolol.
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