What is included in the physical exam to evaluate calcium channel blocker (CCB) toxicity?

Updated: Jan 04, 2021
  • Author: B Zane Horowitz, MD, FACMT; Chief Editor: Michael A Miller, MD  more...
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The cardiac, vascular, and neurologic examinations deserve particular attention because calcium channel blocker (CCB) toxicity manifests most physical findings in these systems. According to one study, elapsed time to onset of symptoms ranged from 3 hours (seen with normal preparations) to 14 hours (in the setting of sustained-release medications). [14] These onset times should be considered when discharging patients home who may or may not have ingested calcium channel blockers.

Measurement of vital signs may reveal a slowed heart rate if the sinoatrial (SA) node blockade occurs, or an increased heart rate if the patient is experiencing reflex tachycardia secondary to peripheral vasodilation and hypotension. Hypotension may last over 24 hours with some sustained-release, long-acting preparations.

When examining the head, eyes, ears, nose, and throat, evaluate the patient's pupil size and reactivity to light. Specifically, look for focal neurologic deficits. A detailed neurologic examination should be performed, and the findings should be documented. With the exception of nimodipine, calcium channel blockers have poor CNS penetration. Therefore, drowsiness, seizures, or altered mental status in the absence of hemodynamic collapse should alert the physician to the possibility of co-ingestions.

Examine the abdomen and listen for bowel sounds, because calcium channel blockers may cause enteric dysmotility. Bowel perforation secondary to calcium channel blocker ingestions has been reported. Peritoneal signs of rebound and guarding are ominous findings.

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