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. 2025 Feb;29(2):130-136.
doi: 10.5005/jp-journals-10071-24906. Epub 2025 Jan 31.

Hemoadsorption Therapy for Calcium Channel Blocker Overdose at a Tertiary-level Intensive Care Unit: A Retrospective Study

Shahed Omar  1 , Varadaben Shukla  1 , Ayesha B Khan  1 , Ziyaad Dangor  2
Affiliations

Hemoadsorption Therapy for Calcium Channel Blocker Overdose at a Tertiary-level Intensive Care Unit: A Retrospective Study

Shahed Omar et al. Indian J Crit Care Med. 2025 Feb.

Abstract

Objective: To describe the burden of calcium channel blocker (CCB) overdose at a tertiary intensive care unit (ICU).

Design and setting: Retrospective study of patients admitted to the ICU with CCB overdose from 2020 to 2022.

Participants: Adult participants with clinically confirmed CCB overdose.

Main outcome: Admission frequency, management strategies, and patient outcomes.

Results: A total of 1719 ICU admissions over the study period, 24 (1.4%) had CCB overdose with a case fatality rate of 12.5% (3/24). Interventions included mechanical ventilation (MV) (71%), vasopressors (92%), high-dose insulin euglycemic therapy (HIET) (71%), calcium (42%), methylene blue (4%), and fluid therapy (100%). Thirteen patients (54%) received hemoadsorption therapy (HA), and eleven received standard of care (SoC) based on current guidelines. The resin hemoadsorption group had a higher SAPS II score (p = 0.002), and a greater total maximal vasopressor dose (p = 0.001) than SoC group. The HA group also had a lower admission mean arterial pressure (MAP), (p = 0.014), a greater MAP increase at 48 hours (p = 0.044), and a longer ICU length of stay (LOS) (p = 0.004) compared to the SoC group. There was one death in the HA group (7.7%) and two in the SoC group (18.2%).

Conclusion: Calcium channel blocker overdose is an important and life-threatening cause of toxicology admissions in the ICU. Modern resin HA may contribute to improved hemodynamic stability providing a safe and important rescue therapy in cases with refractory shock. Well-designed studies are required to confirm its role in enhancing drug clearance thereby improving the hemodynamic state and clinical outcomes.

How to cite this article: Omar S, Shukla V, Khan AB, Dangor Z. Hemoadsorption Therapy for Calcium Channel Blocker Overdose at a Tertiary-level Intensive Care Unit: A Retrospective Study. Indian J Crit Care Med 2025;29(2):130-136.

Keywords: Calcium channel blocker overdose; Critically ill; Extracorporeal blood purification; Hemoadsorption; Hypotension; Toxicology.

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Conflict of interest statement

Source of support: Nil Conflict of interest: NoneConflict of interest: None

Figures

Fig. 1
Fig. 1
Circuit configuration. Pump speed: 150–180 mL/min. Predilution (bicarbonate buffer) at 500 mL/h. Heparin load: 20 U/kg body weight. Heparin infusion into the circuit: 15 U/kg/h × 6 hours. Cycle 1 duration: 6 hours. Interval 12–18 hours. Cycle 2 duration 6 hours
Fig. 2
Fig. 2
Study flow diagram
Fig. 3
Fig. 3
Changes in median lactate levels (mmol/L) over the first day. X-axis: T = time in hours. Y-axis. Median lactate concentration in mmol/L. IQR in parenthesis. *Significant difference between median HA and SC groups. Median lactate levels were similar at admission (T = 0 hour, p = 0.93) and at all time points during the first 24 hours except for T = 14 hours, p = 0.028. Median lactate levels in the SoC group peaked at T = 3 hours, while in the HA group, they peaked at T = 14 hours. Peak lactate in the SoC group decreased over the next 11 hours to reach a nadir, while in the HA group, it decreased over the next 6 hours to reach its lowest at T = 20 hours. At this point, there was no significant difference between the two groups, p = 0.66
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