Pediatric Calcium Channel Blocker Polypharmacy Overdose in a Resource-Limited Emergency Department: Full Recovery After ECMO

Intentional overdose remains a significant public health concern, with calcium channel blockers (CCBs) frequently implicated due to their common use in managing hypertension and cardiac conditions. CCB toxicity is particularly life-threatening, as inhibition of L-type calcium channels can lead to profound bradycardia, hypotension, cardiogenic shock, and death. Early and aggressive intervention is essential, with prior studies supporting therapies such as extracorporeal membrane oxygenation (ECMO) and intralipid administration in severe cases. A 15-year-old male with a history of anxiety and depression presented to the ED following intentional ingestion of over 100 pills, including verapamil, sertraline, risperidone, gabapentin, and levetiracetam. Initially stable, he rapidly deteriorated, experiencing a generalized tonic-clonic seizure and refractory hypotension. Despite initial stabilization at a critical access hospital, he required transfer to a quaternary care center, where he received advanced toxicologic and critical care, including ECMO and hyperinsulinemic-euglycemia therapy. The patient made a full recovery and was discharged home neurologically intact on hospital day 11. Calcium channel blocker overdoses can rapidly progress from mild symptoms to refractory shock and death, particularly in pediatric polypharmacy ingestions and resource-limited settings. This case demonstrates that early recognition, prompt stabilization, and expedited transfer for advanced therapies such as high-dose insulin and ECMO can result in full neurologic recovery even after profound cardiovascular collapse.