High dose insulin for beta-blocker and calcium channel-blocker poisoning

Cole, Jon B.; Arens, Ann M.; Laes, JoAn R.; Klein, Lauren R.; Bangh, Stacey A.; Olives, Travis D.

doi:10.1016/j.ajem.2018.02.004

Cited by 39 publications

(77 citation statements)

References 43 publications

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“…In several cases, patients survived with preserved neurologic function . A recent retrospective chart review found that the incidence of hypoglycemia was lower when euglycemia was maintained with IV dextrose concentrations of 20% or greater …”

Section: Discussion and Implications For Practicementioning

confidence: 99%

“…Hypomagnesemia is also possible and has the potential to result in seizures . Current literature noted that these electrolyte abnormalities are common but often do not result in serious complications . One HIET protocol calls for monitoring of magnesium and phosphorous every 4–6 hours .…”

Section: Discussion and Implications For Practicementioning

confidence: 99%

“…The authors did not report data on other electrolyte abnormalities such as hypomagnesemia or hypophosphatemia that may limit the clinical utility of this study. Forty‐one patients in this study experienced cardiac arrest, of which 31 died …”

Section: Current Literaturementioning

confidence: 98%

“…A recently published chart review was conducted for 199 patients treated with HIET for BB and CCB overdose at a pharmacist‐based poison center from 2000–2016 . All cases in this study were overseen by certified specialists in toxicology.…”

Section: Current Literaturementioning

confidence: 99%

“…PHARMACOTHERAPY Volume 38, Number 11, 2018 A recently published chart review was conducted for 199 patients treated with HIET for BB and CCB overdose at a pharmacist-based poison center from 2000-2016. 36 All cases in this study were overseen by certified specialists in toxicology. There were 10.5% of patients who experienced major hypokalemia (lower than 2.8 mEq/L), and 20.1% of patients experienced significant hypoglycemia (lower than 70 mg/ dl).…”

mentioning

confidence: 99%

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

Krenz

Kaakeh

2018

Pharmacotherapy

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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.

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Section: Discussion and Implications For Practicementioning

confidence: 99%

Section: Discussion and Implications For Practicementioning

confidence: 99%

Section: Current Literaturementioning

confidence: 98%

Section: Current Literaturementioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

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

Krenz

Kaakeh

2018

Pharmacotherapy

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Part II: Interactive case: Toxicology and poison control

Stanton¹

2022

J Am Coll Clin Pharm

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LEARNING OBJECTIVES1. Justify the role of poison control centers in current and future toxicology practice.2. Distinguish among the current treatments of acetaminophen toxicity.3. Assess the role and place in therapy of physostigmine and rivastigmine for anticholinergic toxicity.4. Evaluate a patient with methanol or ethylene glycol toxicity.5. Design a therapeutic regimen for a patient with β-blocker or calcium channel blocker poisoning.

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Kreislaufstillstand unter besonderen Umständen

Lott

Truhlář

Alfonzo

et al. 2021

Notfall Rettungsmed

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Diese Leitlinien des European Resuscitation Council (ERC) für den Kreislaufstillstand unter besonderen Umständen basieren auf dem 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. Dieses Kapitel enthält Leitlinien zu den Modifikationen der lebensrettenden Basismaßnahmen und erweiterten lebensrettenden Maßnahmen zur Vorbeugung und Behandlung von Kreislaufstillständen unter besonderen Umständen; insbesondere spezielle Ursachen (Hypoxie, Trauma, Anaphylaxie, Sepsis, Hypo‑/Hyperkaliämie und andere Elektrolytstörungen, Hypothermie, Lawinengeschehen, Hyperthermie und maligne Hyperthermie, Lungenembolie, Koronarthrombose, Herzbeuteltamponade, Spannungspneumothorax, Giftstoffe), spezielle Umstände (Operationssaal, Herzchirurgie, Herzkatheterlabor, Dialyseeinheit, Zahnkliniken, Transport während des Flugs, Kreuzfahrtschiffe, Sport, Ertrinken, Großschadensereignisse) und spezielle Patientengruppen (Asthma und chronisch obstruktive Lungenerkrankung, neurologische Erkrankungen, krankhafte Adipositas, Schwangerschaft). Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s10049-021-00891-z) enthält das originale Zusatzmaterial aus dem Artikel in Resuscitation. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.

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High dose insulin for beta-blocker and calcium channel-blocker poisoning

Cited by 39 publications

References 43 publications

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

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

Part II: Interactive case: Toxicology and poison control

Kreislaufstillstand unter besonderen Umständen

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