What is the role of glucose levels in the workup of 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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Answer

Calcium channel blocker (CCB) overdose can result in hyperglycemia from impaired insulin release. Hyperglycemia can help distinguish CCB toxicity from beta-blocker toxicity, which produces a very similar clinical picture but often lowers the glucose level.

Levine et al retrospectively analyzed 40 nondihydropyridine overdoses and found that the severity of toxicity correlated directly with the degree of hyperglycemia. For patients requiring temporary pacemaker placement or vasopressor support compared with those who did not, median initial serum glucose concentrations were 188 mg/dL and 129 mg/dL, respectively. The median peak serum glucose concentrations for those 2 groups were 364 mg/dL and 145 mg/dL, respectively. [20]


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