On calcium channel antagonist poisoning

Almost 500 years ago, Paracelsus already stated: ‘Sola dosis facit venenum’. This famous adage underlines a basic principle in the world of toxicology: every substance can be poisonous, as long as the dose is high enough. This fundamental rule still applies in modern times, reflected by the substantial burden of both accidental and intentional poisoning in the US. Also in the Netherlands, an astonishing documented number of 33,700 patients were exposed to toxic substances in 2014, mostly pharmaceutical drugs (56%), followed by household cleaning substances (16%) and food, drinks and stimulants (7%).

In contrast to the current era of evidence-based medicine, many antidotes or treatment strategies in intoxicated patients are solely based on anecdotal reports, case series, animal studies and expert opinions. This is reflected by the absence of clear guidelines and further underlined by the findings of Duineveld and colleagues, who demonstrated considerable variation in the care of intoxicated patients in Dutch hospitals. In a subsequent prospective study, two algorithms to predict the need for treatment in intoxicated patients were implemented in clinical practice, with promising results in terms of good sensitivity and better specificity than routine clinical care. These findings underscore the need for evidence-based practical guidelines, in order to improve clinical care and maximise efficacy.