A 45-year-old man is in the ICU following a massive calcium channel blocker overdose 36 hours ago. He is on assist-control ventilation, has a central line for infusions, and an arterial line for continuous blood pressure monitoring. Initial treatment included glucagon and calcium, but due to persistent hypotension, high-dose insulin (HDI) therapy was initiated and is currently infusing at 2 units/kg/hr alongside a 10% dextrose infusion. His norepinephrine requirement has decreased to 0.05 mcg/kg/min. Current vital signs are stable with a mean arterial pressure of 70 mmHg, lactate is 2.1 mmol/L, and serum glucose is 150 mg/dL. In addition to glucose, which laboratory parameter is most critical to monitor frequently to prevent a life-threatening complication of his ongoing HDI therapy?

A 45-year-old, 75-kg man is recovering in the intensive care unit after presentation for a severe calcium channel blocker overdose. On admission, his blood pressure was 80/50 mm Hg and heart rate was 50 bpm. He received high-dose insulin euglycemic therapy and a norepinephrine infusion via a central venous catheter. Over the past 24 hours, his hemodynamics have stabilized and both infusions have been discontinued. He is tolerating oral intake, his mental status is at baseline, and he is being prepared for transfer to a general medical floor. His most recent laboratory results are a serum glucose of 110 mg/dL and potassium of 4.2 mEq/L. He remains on continuous cardiac monitoring. Which of the following is the MOST critical consideration for this patient’s transition-of-care plan to mitigate immediate risks related to his recent intensive therapies?

A 65-year-old, 80-kg man is admitted to the critical care unit after an intentional overdose of verapamil. He is intubated and on assist-control mechanical ventilation. Despite aggressive fluid resuscitation, calcium chloride 1 g IV, and a norepinephrine infusion titrated to 0.5 mcg/kg/min, his mean arterial pressure remains refractory at 45–50 mmHg, and his heart rate is 38 bpm. An arterial line is in place for continuous hemodynamic monitoring. During nursing rounds, he is noted to have cool extremities with delayed capillary refill. His initial serum lactate was 6.2 mmol/L, and a repeat lactate 2 hours later has increased to 7.8 mmol/L. Bedside echocardiography shows severely depressed left ventricular function. Given the patient’s refractory cardiogenic shock and persistent bradycardia following a verapamil overdose, which adjunctive pharmacologic therapy should be prioritized to improve hemodynamic stability?

A 62-year-old man with an intentional verapamil overdose developed cardiogenic shock requiring norepinephrine and high-dose insulin infusions. Initial labs showed lactic acidosis (lactate 8.2 mmol/L, pH 7.18). Over the past 12 hours, his mean arterial pressure has stabilized at ≥70 mmHg on decreasing vasopressors. Which laboratory parameter is most critical to monitor frequently to guide safe de-escalation of vasopressor and insulin therapy?

A 45-year-old man is admitted to the ICU after suspected calcium channel blocker overdose. He is on norepinephrine and vasopressin to maintain a MAP >65 mmHg and has an intra-aortic balloon pump placed for cardiogenic shock. On exam he is bradycardic (38 bpm) and hypotensive (70/40 mmHg). Initial labs show pH 7.28, PaCO₂ 48 mmHg, HCO₃⁻ 20 mEq/L, lactate 3.5 mmol/L, and creatinine 1.0 mg/dL. Which of the following is the most critical initial monitoring strategy to guide ongoing management?

A 45-year-old man presents after an intentional overdose of unknown cardiovascular medications (likely beta-blockers or calcium channel blockers) resulting in hypotension and bradycardia requiring norepinephrine support. His wife reports that he has been unemployed and obtained “heart pills” from a neighbor to self-medicate for anxiety. In addition to acute toxicity management, which of the following interventions is most critical to prevent a future overdose in this patient?

A 45-year-old man is in the intensive care unit following an intentional calcium channel blocker overdose that resulted in profound bradycardia and hypotension. He was stabilized with high-dose insulin therapy (HDI), glucagon, and a norepinephrine infusion via a central venous catheter. He is intubated and receiving assist-control ventilation. After 24 hours, his hemodynamics have improved, and the norepinephrine has been weaned off. The team plans to de-escalate the HDI infusion. Which parameter should be monitored most frequently to prevent a common, life-threatening complication of HDI therapy?

A 51-year-old woman is in the intensive care unit following an intentional overdose of amlodipine and bisoprolol. She received: 2 L of crystalloid, calcium chloride 1 g IV, a glucagon 10 mg IV bolus then 5 mg/hr infusion started 3 hours ago (with two subsequent 10 mg boluses), and norepinephrine at 0.1 mcg/kg/min. High-dose insulin (HDI) therapy (1 unit/kg/hr) with 10% dextrose infusion was initiated 2 hours ago to maintain blood glucose 100–150 mg/dL. Her most recent central-line labs show potassium 3.1 mEq/L (on continuous KCl repletion at 10 mEq/hr) and glucose 145 mg/dL. Despite these measures, her mean arterial pressure remains 55 mmHg with persistent vasoplegia. Which of the following is the most appropriate next intervention?

A 45-year-old man (weight 70 kg) is admitted to the intensive care unit after an intentional overdose of a calcium channel blocker. He remains intubated and is receiving norepinephrine at 0.1 mcg/kg/min and high-dose insulin at 5 units/kg/hr via a central line. Over the past 12 hours, his mean arterial pressure has been consistently ≥ 65 mmHg, heart rate 70–80 bpm, urine output > 0.5 mL/kg/hr, and mental status has improved with him now following commands. Initial labs showed lactate 6.2 mmol/L, creatinine 1.8 mg/dL (baseline 0.9 mg/dL), AST/ALT 150/120 U/L; current labs are lactate 1.5 mmol/L, creatinine 1.0 mg/dL, AST/ALT 45/35 U/L. Given this early stabilization, which adjustment to the frequency of laboratory monitoring for organ perfusion markers (serum creatinine, lactate, liver enzymes) is most appropriate at this time?

A 45-year-old man is in the ICU after a severe intentional calcium channel blocker overdose. He is intubated and on assist-control ventilation. He currently receives high-dose insulin infusion at 15 units/kg/hr and norepinephrine at 0.2 µg/kg/min via a central line to maintain a mean arterial pressure (MAP) >65 mmHg. Over the past 24 hours, his MAP has been stable at 70–75 mmHg, heart rate 65–70 bpm, and urine output 0.8 mL/kg/hr. His latest labs show serum glucose 110 mg/dL, potassium 4.1 mEq/L, and lactate 1.2 mmol/L. Given this stable clinical status, what is the most appropriate next step in managing his vasoactive and metabolic support?