Insulin versus vasopressin and epinephrine to treat β-blocker toxicity

Holger, Joel S.; Engebretsen, Kristin M.; Fritzlar, Sandy J.; Patten, Lane C.; Harris, Carson R.; Flottemesch, Thomas J.

doi:10.1080/15563650701285412

Cited by 64 publications

(57 citation statements)

References 17 publications

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“…Current recommendations for the treatment of β-blocker poisoning advocate infusion of catecholamines [12], calcium chloride [13], glucagon [14,15] and extracorporeal life support [16] in instances of refractory cardiovascular collapse. More recently, high-dose insulin-glucose euglycaemia [17,18] and Levosimendan [19] have been demonstrated effective in animal models and clinical cases of β-blocker toxicity.…”

Section: Introductionmentioning

confidence: 99%

Intravenous Lipid Emulsion Does Not Augment Blood Pressure Recovery in A Rabbit Model of Metoprolol Toxicity

2010

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Intravenous lipid emulsion (ILE) has been demonstrated to be an effective treatment for systemic toxicity associated with local anaesthetics and increasingly non-local anaesthetic agents of high lipophilicity. Effect for ILE has been demonstrated in animal models of propranolol poisoning; however, any benefit for ILE in more hydrophilic β-blockers remains uncertain. We determined to examine the effect of ILE on haemodynamic recovery following induction of hypotension with the relatively hydrophilic β-blocker, metoprolol. Twenty sedated, invasively monitored and mechanically ventilated adult New Zealand white rabbits underwent metoprolol infusion to mean arterial pressure (MAP) 60% baseline. Intravenous rescue was given according to the following groups: 6 mL/kg 20% lipid emulsion or 6 mL/kg 0.9% saline solution over 4 min. Haemodynamic parameters were obtained in 15 min. MAP was 70 (interquartile range (IQR), 58-82) mmHg saline group and 79 (IQR,(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89) mmHg ILE group at baseline, and 38 (IQR, 33-40) mmHg saline group and 41 (IQR, 40-43) mmHg ILE group, respectively, following metoprolol infusion. No statistically significant difference between ILE and saline-treated groups was observed in MAP, or pulse rate, at any time point following rescue therapy. ILE was not effective in reversal of metoprolol-induced hypotension in this rabbit model. These findings lend inferential support for the 'lipid sink' as principal mechanism for the beneficial effect observed with ILE administration in other models of lipophilic β-blocker-induced toxicity.

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Section: Introductionmentioning

confidence: 99%

Intravenous Lipid Emulsion Does Not Augment Blood Pressure Recovery in A Rabbit Model of Metoprolol Toxicity

2010

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“…Therapieerfolge sind beim Einsatz von Glucagon (50-150 μg/kgKG, [357][358][359][360][361][362][363][364][365][366][367][368][369][370]), hochdosierter Insulin-und Glukosegabe [371][372][373], Lipidemulsionen [374][375][376][377], Phosphodiesterasehemmern [378,379], extrakorporaler Unterstützung und IAPB-Einsatz (intraaortale Ballonpumpe, [380][381][382] …”

Section: Beta-blockerunclassified

Kreislaufstillstand in besonderen Situationen

Truhlář

Deakin

Soar

et al. 2015

Notfall Rettungsmed

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“…The dose response relationship of high dose insulin and hemodynamic effects was shown in pigs after induced poisoning with propranolol, where the cardiac output continued to rise in response to insulin doses exceeding 5 Units/kg/hour [13,14]. The inotropic effect of high-dose insulin after verapamil intoxication in canine models has been shown in several studies, even when standard therapy proved ineffective [15][16][17][18].…”

Section: Introductionmentioning

confidence: 92%

“…The inotropic effect of high-dose insulin after verapamil intoxication in canine models has been shown in several studies, even when standard therapy proved ineffective [15][16][17][18]. In short, animal studies showed the ability of high dose insulin to reverse catecholamine and glucagon-refractory overdoses with beta-adrenergic blockers and/or calcium channel blockers, as well as partial reversal of LPS induced shock [13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Experience using high-dose glucose-insulin-potassium (GIK) in critically ill patients

Slob

Shulman

Singer

2017

Journal of Critical Care

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Purpose To audit the use of GIK in terms of safety, haemodynamic effects, and impact on catecholamine dosage.Materials and methods A retrospective, descriptive, evaluative audit of GIK use within the adult ICU of a London teaching hospital was conducted. Rescue therapy of GIK (up to 1.0 Units insulin/kg/hour) was administered to improve cardiac function. Outcomes were ICU survival, change in cardiac index (CI) and blood lactate levels, events of hypoglycaemia, hyperglycaemia, hypokalaemia and hyperkalaemia, and discontinuation time of catecholamine inotropes. ResultsOf 85 patients treated with GIK, 13 (15.3%) survived their ICU stay and 9 (10.5%) were discharged home. In patients surviving until 72 hours, a trend of improved CI and lactate levels was seen, often with reductions in catecholamine dosing. Inotropes were discontinued in 35 (54%) patients. Severe hypoglycaemia (<2 mmol/l), hyperglycaemia (>20 mmol/l), hypokalaemia (<2.5 mmol/l) and hyperkalaemia (>7 mmol/l) during GIK affected 1, 6, 8 and 1 patients, respectively. These abnormalities were quickly identified. No measurable harm was noted.Conclusions High-dose GIK can be safely used in critically ill patients, though blood glucose and potassium levels must be monitored frequently. GIK was associated with improved CI and blood lactate levels. Impact on survival requires prospective evaluation.

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Insulin versus vasopressin and epinephrine to treat β-blocker toxicity

Abstract: In this swine model, IN/G is superior to V/E to treat beta-blocker toxicity. IN/G has marked inotropic properties while the vasopressor effects of V/E depress CO and contribute to death. Increasing SVR in this condition is detrimental to survival.

Cited by 64 publications

References 17 publications

Intravenous Lipid Emulsion Does Not Augment Blood Pressure Recovery in A Rabbit Model of Metoprolol Toxicity

Intravenous Lipid Emulsion Does Not Augment Blood Pressure Recovery in A Rabbit Model of Metoprolol Toxicity

Kreislaufstillstand in besonderen Situationen

Experience using high-dose glucose-insulin-potassium (GIK) in critically ill patients

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