Early use of high‐dose insulin euglycaemic therapy for verapamil toxicity

Nickson, Christopher P; Little, Mark

doi:10.5694/j.1326-5377.2009.tb02822.x

Cited by 12 publications

(53 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Intravenous calcium infusion is logically indicated to overcome intracellular hypocalcemia but the benefit in overdose is unclear and may even be toxic [10]. Hyperinsulinemic euglycemia (HIE) therapy and glucagon administration have been suggested to improve cardiac inotropy and utilization of glucose, with some success [2,11-13]. However, all of these interventions act secondarily by supporting the body while the drug is naturally eliminated, as opposed to directly neutralizing the circulating drug.…”

Section: Introductionmentioning

confidence: 99%

Lipid rescue of massive verapamil overdose: a case report

2011

View full text Add to dashboard Cite

IntroductionMassive intentional verapamil overdose is a toxic ingestion which can cause multiorgan system failure and has no currently known antidote.Case PresentationThe patient is a 41-year-old Caucasian woman who ingested 19.2 g of sustained release verapamil in a suicide attempt. Our patient became hypotensive requiring three high-dose vasopressors to maintain arterial pressure. She also developed acute respiratory failure, bradycardic ventricular rhythm necessitating continuous transvenous pacing, and anuric renal failure. Our patient was treated with intravenous calcium, bicarbonate, hyperinsulinemic euglycemic therapy and continuous venovenous hemodialysis without success. On the fourth day after hospital admission continuous intravenous lipid therapy was initiated. Within three hours of beginning lipid therapy, our patient's vasopressor requirement decreased by half. Within 24 hours, she was on minimal vasopressor support and regained an underlying junctional rhythm. After three days of lipid infusion, she no longer required inotropic agents to maintain blood pressure or pacing to maintain stable hemodynamics.ConclusionsIntravenous fat emulsion therapy may be an effective antidote for massive verapamil toxicity.

show abstract

Section: Introductionmentioning

confidence: 99%

Lipid rescue of massive verapamil overdose: a case report

2011

View full text Add to dashboard Cite

show abstract

“…Most authors have defined a clinical improvement in CCB and BB overdose cases as favorable changes in BP, MAP, HR, and/or mental status. Reported cases saw beneficial increases in these parameters within the range of 30 minutes to 4 hours from the commencement of HIET . Some authors have also noted improvements in slight EKG abnormalities within hours after beginning HIET .…”

Section: Discussion and Implications For Practicementioning

confidence: 92%

“…There does not appear to be any clear indication for when therapy should be discontinued, but the potential exists for patients to deteriorate into cardiac arrest upon premature discontinuation . There are several reports of patients stopping or being tapered off HIET who then experienced significant hypotension that resolved upon HIET reinitiation . Clinicians may have attempted to discontinue HIET in favor of agents they had more familiarity with or due to concern for possible adverse drug events.…”

Section: Discussion and Implications For Practicementioning

confidence: 99%

An Overview of Hyperinsulinemic‐Euglycemic Therapy in Calcium Channel Blocker and β‐blocker Overdose

Krenz

Kaakeh

2018

Pharmacotherapy

View full text Add to dashboard Cite

Both calcium channel blockers (CCBs) and β blockers (BBs) are associated with fatal substance exposures within the United States. Cases of overdose with these agents have the potential to be both complex and difficult to manage. A variety of pharmacologic treatment options are available for clinicians to use to help mitigate harm from these poisonings. Hyperinsulinemic-euglycemic therapy (HIET) was once regarded as a last-ditch effort to treat patients in highly refractory cases. In recent years, this therapy has become a routine therapy in the treatment of CCB/BB overdose. This article provides a literature review regarding HIET in cases of overdose with CCB and BB agents. Relevant literature articles from 1997-2018 were identified and reviewed using the PubMed and Embase databases. The following search terms were used to identify potential articles: "hyperinsulinemic-euglycemic therapy," "overdose," "calcium channel blocker," "beta blocker," and "insulin." Articles published in the English language were included in this review. A manual search of reference lists was also conducted. Much of the literature is limited to case reports, series, retrospective chart reviews, and small prospective studies. The success rate observed in published case series ranged from 80.4-100%. Regular insulin is most commonly dosed at an initial bolus of 1 unit/kg followed by a regular insulin infusion of 0.5-1 unit/kg/hour. Euglycemia is often maintained using intravenous fluids containing dextrose. Hyperinsulinemic-euglycemic therapy exhibited a promising safety profile, provided close monitoring is conducted. More research is needed to determine optimal strategies for maintaining euglycemia, ideal monitoring parameters, and consistent efficacy goals.

show abstract

“…In human medicine, treatment with ILE and HDI are now recommended for initial therapy in treating CCB toxicosis . Although no prospective clinical trials are available to critically assess efficacy, there are multiple animal experimental models and human case reports that support these treatment interventions over previous traditional therapies (eg, glucagon, vasopressors) , , …”

Section: Discussionmentioning

confidence: 99%

“…It should be noted that the insulin infusion could have been increased had the patient not responded clinically and treatment of future cases may consider HDI with doses as high as 10 U/kg/h . In the human literature, it is advocated to pursue ILE and HDI therapies early in cases with severe refractory CCB toxicosis , , . These treatments are relatively novel to veterinary medicine; therefore, initially conservative therapies (including the use of IV fluid therapy, calcium administration, glucagon, and dopamine) were administered.…”

Section: Discussionmentioning

confidence: 99%

The use of high‐dose insulin therapy and intravenous lipid emulsion to treat severe, refractory diltiazem toxicosis in a dog

Maton¹,

Simmonds²,

Lee

et al. 2013

J Vet Emergen Crit Care

View full text Add to dashboard Cite

To the authors' knowledge, this is the first reported clinical case describing the use of both HDI and ILE therapy in the treatment of severe refractory diltiazem toxicosis in veterinary medicine. No significant adverse effects were observed from the treatment. In veterinary patients with severe refractory calcium channel blocker toxicosis, the use of HDI and ILE should be considered for life-threatening clinical signs.

show abstract

Early use of high‐dose insulin euglycaemic therapy for verapamil toxicity

Cited by 12 publications

References 13 publications

Lipid rescue of massive verapamil overdose: a case report

Lipid rescue of massive verapamil overdose: a case report

An Overview of Hyperinsulinemic‐Euglycemic Therapy in Calcium Channel Blocker and β‐blocker Overdose

The use of high‐dose insulin therapy and intravenous lipid emulsion to treat severe, refractory diltiazem toxicosis in a dog

Contact Info

Product

Resources

About