A Novel Dosing Regimen for Calcium Infusion in a Patient of Massive Overdose of Sustained-Release Nifedipine

Although continuous intravenous (IV) calcium infusion is recommended for calcium channel blocker (CCB) overdose, its clinical efficacy is inconsistent and the dosage required is unclear. The authors present a case of a 25-year-old previously healthy woman with massive overdose of sustained-release nifedipine resulting in severe hypotension. The patient was successfully treated with continuous IV calcium gluconate infusion as add-on therapy. What differed this case from the previous ones is the use of an individually tailored protocol for dose titration of IV calcium infusion, in which the “optimal” calcium infusion rate was determined by achieving the lowest possible serum ionic calcium level associated with a maximal contractility (ie, cardiac power index). This strategy, resulting in a lower dosage of calcium administrated and a lower peak serum ionic Ca2+ level achieved, seems a promising therapeutic alternative for the management of CCB overdose and deserves further investigations.