Treatment of CCB overdose consists of three basic objectives: providing supportive care, decreasing drug absorption, and improving cardiac function with cardiotonic agents. Many patients are alert and cooperative, describe a nontoxic CCB overdose (<3 mg/kg for nifedipine, <5 mg/kg for diltiazem or verapamil), and demonstrate sinus rhythm with essentially normal arterial blood pressure. These individuals can be closely monitored noninvasively for 6 to 12 h. Patients who are drowsy and manifest hypotension despite a 15 mL/kg normal saline bolus or show sinus arrest on ECG should be managed aggressively, as outlined below.
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